LAKESIDE FAMILY MEDICINE (NPI# 1790188639) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790188639 |
| Entity Type | Organization |
| Organization Name | LAKESIDE FAMILY MEDICINE |
| Practice Address |
714 Hwy 70 E Kingston OK 73439 |
| Mailing Address |
Po Box 1798 Kingston OK 73439-1798 |
| Practice Telephone | 5805640200 |
| Mailing Telephone | 5805640200 |
| Mailing Fax Number | 5805640201 |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2014-10-07 |
| Authorized Official Name | PAMELA AHEARN (OWNER) |
| Authorized Official Telephone | 5805640200 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200272990A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295064178 | Lakeside Family Medicine | Family Medicine | 21 N. Main Street, Kingston, OK 73439-1798 | 2009-12-23 |
| 1720514029 | Lakeside Family Medicine | Clinic/Center | 104 Carrington Park Dr Ste B, Gainesville, GA 30504-6603 | 2017-05-04 |
| Street Address |
714 HWY 70 E |
| City | KINGSTON |
| State | OK |
| Zip Code | 73439 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407489859 | Amanda Griffin | Behavior Technician | 9236 Polvadore Drive, Kingston, OK 73439 | 2020-02-13 |
| 1659837102 | Sheriden Cheyenne Franks | Pharmacist | 7 North Main Street, Kingston, OK 73439 | 2019-02-20 |
| 1275061467 | Ayandeh Health LLC | Nurse Practitioner | 7 N Main Street, Kingston, OK 73439 | 2017-06-01 |
| 1720526437 | Tammy Lynn Williams | Nurse Practitioner | 7 N Main, Kingston, OK 73439 | 2017-02-02 |
| 1053774794 | Tressa Antionette Matchen | Nurse Practitioner | 701 East Hwy 70 Alliance Health Medical Group, Kingston, OK 73439 | 2016-03-31 |
| 1932577277 | Laura Kay Gleaves | Counselor | 717 B Hwy E, Kingston, OK 73439 | 2015-09-03 |
| 1346622099 | Alicia Thompson | Community Health Worker | 400 North East Third, Kingston, OK 73439 | 2015-06-18 |
| 1518373513 | Dana Boldt Green, M.ed., Lpc, Ncgc-2, PC | Community/Behavioral Health | 8800 Birch St, Kingston, OK 73439 | 2014-07-10 |
| 1205131554 | Marie Morrison Bramlett | Counselor | 400 Ne 3rd St, Kingston, OK 73439 | 2011-01-18 |
| 1316242613 | Henry Lee Franklin | Counselor | 400 Ne Third St, Kingston, OK 73439 | 2011-01-18 |
| Find all providers in zip 73439 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285234252 | Healthstar Physicians of Hot Springs, Pllc | Family Medicine | 220 Madison 2620, Kingston, AR 72742 | 2020-10-29 |
| 1912423468 | Vintage Direct Primary Care | Family Medicine | 25985 Barbr Cutff Rd Ne Ste B1, Kingston, WA 98346-9596 | 2017-08-16 |
| 1063945798 | Danielle Isenburg | Family Medicine | 1240 Ulster Ave Ste 104, Kingston, NY 12401-1517 | 2017-04-10 |
| 1437546140 | Nedal Amin Elass | Family Medicine | 701 Highway 70 E, Kingston, OK 73439-8253 | 2015-04-20 |
| 1033459680 | Health Quest Medical Practice | Family Medicine | 40 Hurley Ave Ste 18, Kingston, NY 12401-3738 | 2013-02-19 |
| 1295064178 | Lakeside Family Medicine | Family Medicine | 21 N. Main Street, Kingston, OK 73439-1798 | 2009-12-23 |
| 1871769125 | Ira Vohra | Family Medicine | 610 Wyoming Ave Ste 1, Kingston, PA 18704-3702 | 2008-05-07 |
| 1801067145 | Michael E Fath, D.o., P.c | Family Medicine | 618 Wyoming Ave, Kingston, PA 18704-3702 | 2008-03-14 |
| 1275702961 | Baptist Healthcare of Oklahoma | Family Medicine | 700 S Muncrief At Hwy 70, Kingston, OK 73439-0762 | 2008-02-27 |
| 1134308471 | Joseph F Kerbleski | Family Medicine | 368 Broadway Ste 202, Kingston, NY 12401-5160 | 2007-11-02 |
| Find all providers in KINGSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.