LAKE GIRL INC NPI 1255730446

NPI Information

  • NPI: 1255730446
  • Provider Name: LAKE GIRL, INC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Doing Business As: HOMETOWN FAMILY MEDICINE
  • CLIA Number: 26D2083368
  • Address: 4581 GRAVOIS RD
    HOUSE SPRINGS, MO
    ZIP 63051
  • Phone: (636) 671-9980

Map and Directions

Get Directions

NPI Details

LAKE GIRL, INC is a primary care clinic center in House Springs, MO. LAKE GIRL, INC NPI is 1255730446. The provider is registered as an organization entity type.
The provider Is Doing Business As Hometown Family Medicine.

The provider's business location address is:

4581 GRAVOIS RD
HOUSE SPRINGS, MO
ZIP 63051-374
Phone: (636) 671-9980
Fax: (636) 671-9981

The provider's authorized official is Renee L Willer .
The authorized official title is Owner and has the following contact phone number (314) 322-7017.

The CLIA number assigned to this NPI record is 26D2083368 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/14/2014 and was last updated on 12/21/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary Care138512MISSOURIYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI