| Lakeside Health Clinic, P.c. | |
|
813 E Wood St Paris TN 38242-4223 | |
| (731) 924-2000 | |
| (731) 653-0053 |
| Full Name | Lakeside Health Clinic, P.c. |
|---|---|
| Speciality | General Practice |
| Location | 813 E Wood St, Paris, Tennessee |
| Authorized Official Name and Position | Lisa Hubbard (OWNER/PA-C) |
| Authorized Official Contact | 7319242000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Health Clinic, P.c. Po Box 1269 Paris TN 38242-1269 Ph: (731) 924-2000 | Lakeside Health Clinic, P.c. 813 E Wood St Paris TN 38242-4223 Ph: (731) 924-2000 |
| NPI Number | 1336492495 |
|---|---|
| Provider Enumeration Date | 10/25/2012 |
| Last Update Date | 02/16/2024 |
| Medicare PECOS PAC ID | 4082867882 |
|---|---|
| Medicare Enrollment ID | O20130103000107 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336492495 | NPI | - | NPPES |
| 1530820 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| Provider Name | Leslie Leeann Ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790063212 PECOS PAC ID: 0547430621 Enrollment ID: I20110829000031 |
| Provider Name | Amanda Riggins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831783000 PECOS PAC ID: 8628462702 Enrollment ID: I20220307001816 |
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