LAKESHORE ENT
NPI 1003096991
Otolaryngology - Facial Plastic Surgery in Granbury, TX
NPI Status: Active since November 07, 2007
Contact Information
1305 PALUXY RD
SUITE A
GRANBURY, TX
ZIP 76048
Phone: (817) 573-6673
Fax: (817) 573-9783
- Organization
- Otolaryngology
- Facial Plastic Surgery
- Accepts Insurance
- CLIA Number: 45D0954953
- CLIA Cert. Type: Independent
- CLIA Exp. Date: 10-19-2027
About LAKESHORE ENT
This page provides the complete NPI Profile along with additional information for Lakeshore Ent, a provider established in Granbury, Texas operating as a Otolaryngology, focusing in facial plastic surgery . The healthcare provider is registered in the NPI registry with number 1003096991 assigned on November 2007. The practitioner's primary taxonomy code is 207YS0123X with license number K8272 (TX). The provider is registered as an organization and their NPI record was last updated one year ago. Lakeshore Ent operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Dr. Stephen George Krzeminski D.o., Faoco (Owner)
- NPI
- 1003096991
- Provider Name
- LAKESHORE ENT
- Entity Type
- Organization
- Location Address
- 1305 PALUXY RD SUITE A GRANBURY, TX 76048
- Location Phone
- (817) 573-6673
- Location Fax
- (817) 573-9783
- Mailing Address
- 1305 PALUXY RD SUITE A GRANBURY, TX 76048
- Mailing Phone
- (817) 573-6673
- Mailing Fax
- (817) 573-9783
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-07-2007
- Last Update Date
- 08-15-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Otolaryngology Facial Plastic Surgery
- Taxonomy Code
- 207YS0123X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- K8272
- License State
- TX
- Taxonomy Description
- An otolaryngologist who specializes in facial plastic surgery.
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Wellpoint Essential Bronze 4000 HSA (+ Incentives) - HMO
- Wellpoint Essential Bronze 6000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Bronze 6000 Adult Dental/Vision ($0 Virtual PCP+$0 Select Drugs) - HMO
- Wellpoint Essential Bronze 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Bronze POS 4500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Wellpoint Essential Bronze POS 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Wellpoint Essential Bronze POS 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Wellpoint Essential Catastrophic (+ Incentives) - HMO
- Wellpoint Essential Gold 1500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Gold 2000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Gold POS 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Wellpoint Essential Gold POS 2000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Wellpoint Essential Gold POS 700 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Wellpoint Essential Silver 1850 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Silver 3500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Silver 3500 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Silver 6000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Silver POS 2500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Wellpoint Essential Silver POS 4000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 45D0954953
- Facility Type
- Independent
- Certificate Effective Date
- October 20, 2025
- Certificate Expiration Date
- October 19, 2027
- Laboratory Director
- RUSSELL CRUM
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Lakeshore Ent after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
Reviews for LAKESHORE ENT
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1003096991, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 59 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 3 providers are registered at the same or a nearby location.
GRANBURY, TX 76048
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1003096991, enumerated as an "organization" on November 07, 2007.
The provider is located at 1305 PALUXY RD SUITE A GRANBURY, TX 76048 and the phone number is (817) 573-6673.
Otolaryngology with taxonomy code 207YS0123X and a focus in Facial Plastic Surgery.
The provider might be accepting Accepts: WellPoint. Please consult your insurance carrier or call the provider to verify.
