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LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC
NPI 1003975087
Pediatrics - Adolescent Medicine in Coeur D'alene, ID

Active since December 06, 2006CLIA 13D1004948 · Waiver
980 W IRONWOOD DR, STE 302, COEUR D'ALENE, ID 83814(208) 292-5437(208) 292-5441 Get Directions Write a Review

NPPES record last updated: July 12, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lakeside Pediatric & Adolescent Medicine, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC (NPI 1003975087) is a healthcare organization registered as an adolescent medicine in Coeur D'alene, Idaho and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through December 14, 2026 and lists Diana R Vanhook, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1003975087
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameLAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, PLLC
Location Address980 W IRONWOOD DR, STE 302Coeur D'alene, ID 83814-2601
Mailing Address980 W Ironwood Dr, Ste 302Coeur D'alene, ID 83814-2601 · (208) 292-5437 · Fax (208) 292-5441
Phone(208) 292-5437
Fax(208) 292-5441
Organization SubpartNo
Authorized OfficialDiana R VanhookOffice Manager · (208) 292-5437
Enumeration DateDecember 6, 2006
Last NPPES UpdateJuly 12, 2012
✔ NPI 1003975087 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
980 W IRONWOOD DR, Coeur D'alene, ID 83814
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Other Identifiers 2

Medicaid806408200ID
Other4010138351ID · Regence Blue Shield Group

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D1004948

Lakeside Pediatric & Adolescent Medicine PLLC · Coeur D'alene, ID
Active · expires Dec 14, 2026
CLIA Number13D1004948
Laboratory TypePhysician Office
Certificate Effective DateDecember 15, 2024
Certificate Expiration DateDecember 14, 2026
Laboratory DirectorJean Prince
Laboratory Phone(208) 292-5437
Laboratory LocationLakeside Pediatric & Adolescent Medicine PLLC980 W Ironwood Dr Ste #302, Coeur D'alene, ID 83814
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARSTON T WESTBROOK , DDS, LLC
Dentist (Oral and Maxillofacial Surgery)
980 W IRONWOOD DR, SUITE 301
COEUR D ALENE, ID 83814
Kootenai County (208) 664-0844
ROY RANDEL HENNEBERG MD
Specialist
980 W IRONWOOD DR, SUITE 304
COEUR D ALENE, ID 83814
Kootenai County (208) 765-4888
MR. STEVEN I JESSUP M.A. LIC. ATC
Specialist/Technologist (Athletic Trainer)
980 W IRONWOOD DR, SUITE 207
COEUR D ALENE, ID 83814
Kootenai County (208) 770-2971
MATTHEW DAVID MCLAUGHLIN D.O.
Urology
980 W IRONWOOD DR, STE 104
COEUR D ALENE, ID 83814
Kootenai County (208) 667-0621
RONDA LYNN WILLIAMSON CNM
Advanced Practice Midwife
980 W IRONWOOD DR, STE 306
COEUR D ALENE, ID 83814
Kootenai County (208) 625-4970
MRS. SUZANNE KALEN EPPERSON ARNP-CNM
Midwife
980 W IRONWOOD DR
COEUR D ALENE, ID 83814
Kootenai County (208) 765-4888
APPLE FAMILY CARE PLLC
Family Medicine
980 W IRONWOOD DR, SUITE 201
COEUR D ALENE, ID 83814
Kootenai County (208) 292-1315
MR. FREDRICK MARK OWSLEY M.D.
Specialist
980 W IRONWOOD DR, STE 206
COEUR D ALENE, ID 83814
Kootenai County (208) 664-0165

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakeside Pediatric & Adolescent Medicine, PLLC's NPI number?

The NPI number for Lakeside Pediatric & Adolescent Medicine, PLLC is 1003975087. It was assigned to this organization in the NPPES registry on December 6, 2006.

Where is Lakeside Pediatric & Adolescent Medicine, PLLC located?

Lakeside Pediatric & Adolescent Medicine, PLLC is located at 980 W Ironwood Dr Ste 302, Coeur D'alene, ID 83814. The listed phone number is (208) 292-5437.

What is Lakeside Pediatric & Adolescent Medicine, PLLC's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Does Lakeside Pediatric & Adolescent Medicine, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D1004948) is associated with this NPI, valid through December 14, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lakeside Pediatric & Adolescent Medicine, PLLC was last updated on July 12, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.