| Lakeside Family Practice Pllc | |
|
933 Cheat Rd Morgantown WV 26508-5631 | |
| (304) 594-2400 | |
| (304) 594-2256 |
| Full Name | Lakeside Family Practice Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 933 Cheat Rd, Morgantown, West Virginia |
| Authorized Official Name and Position | Brian W Hawthorne (PRESIDENT) |
| Authorized Official Contact | 3045942400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Family Practice Pllc 933 Cheat Rd Morgantown WV 26508-5631 Ph: (304) 594-2400 | Lakeside Family Practice Pllc 933 Cheat Rd Morgantown WV 26508-5631 Ph: (304) 594-2400 |
| NPI Number | 1205919917 |
|---|---|
| Provider Enumeration Date | 10/24/2006 |
| Last Update Date | 05/09/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205919917 | NPI | - | NPPES |
| 001709238 | Other | WV | BLUE SHIELD GROUP PROVIDE |
| 3810002243 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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