LAKESIDE YOUTH N KIDS PEDIATRICS NPI 1275903833

NPI Information

NPI: 1275903833
Provider Name: LAKESIDE YOUTH N KIDS PEDIATRICS
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 06D2105311

Address:
6055 W 46TH AVE
WHEAT RIDGE, CO
ZIP 80033
Phone: (916) 300-7534
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LAKESIDE YOUTH N KIDS PEDIATRICS is a primary care clinic center in Wheat Ridge, CO. LAKESIDE YOUTH N KIDS PEDIATRICS NPI is 1275903833. The provider is registered as an organization entity type.

The provider's business location address is:

6055 W 46TH AVE
WHEAT RIDGE, CO
ZIP 80033-811
Phone: (916) 300-7534

The provider's authorized official is Lance Jesse Lazatin .
The authorized official title is Physician/owner and has the following contact phone number (916) 300-7534.

The CLIA number assigned to this NPI record is 06D2105311 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/25/2015 and was last updated on 9/25/2015.

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
1	261QP2300X	Clinic/Center	Primary Care	50291	COLORADO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	63008564	MEDICAID	COLORADO

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: 5/5/2024

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