| Lakeside Wellness Center | |
|
1805 S 13th St Wilmington NC 28401-6469 | |
| (910) 772-5552 | |
| Not Available |
| Full Name | Lakeside Wellness Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1805 S 13th St, Wilmington, North Carolina |
| Authorized Official Name and Position | Althea Annette Johnson (CEO) |
| Authorized Official Contact | 9102028623 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Wellness Center 925 N 4th St Wilmington NC 28401-3450 Ph: (910) 343-0270 | Lakeside Wellness Center 1805 S 13th St Wilmington NC 28401-6469 Ph: (910) 772-5552 |
| NPI Number | 1457512766 |
|---|---|
| Provider Enumeration Date | 06/19/2008 |
| Last Update Date | 11/09/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457512766 | NPI | - | NPPES |
| 34-1923 | Other | MEDICARE FACILITY IDENTIFICATION NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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