| Lakeside Family Medicine | |
|
714 Hwy 70 E Kingston OK 73439 | |
| (580) 564-0200 | |
| Not Available |
| Full Name | Lakeside Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 714 Hwy 70 E, Kingston, Oklahoma |
| Authorized Official Name and Position | Pamela Ahearn (OWNER) |
| Authorized Official Contact | 5805640200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Family Medicine Po Box 1798 Kingston OK 73439-1798 Ph: (580) 564-0200 | Lakeside Family Medicine 714 Hwy 70 E Kingston OK 73439 Ph: (580) 564-0200 |
| NPI Number | 1790188639 |
|---|---|
| Provider Enumeration Date | 10/07/2014 |
| Last Update Date | 10/07/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790188639 | NPI | - | NPPES |
| 200272990A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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