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LAKESHORE MEDICAL CARE CENTER, INC
NPI 1124195573
Preferred Provider Organization in Jacksonville, FL

Active since November 29, 2006
4616 SAN JUAN AVE, JACKSONVILLE, FL 32210(904) 384-5385(904) 388-5838 Get Directions Write a Review

NPPES record last updated: December 27, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Lakeshore Medical Care Center, Inc NPPES

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

LAKESHORE MEDICAL CARE CENTER, INC (NPI 1124195573) is a healthcare organization registered as a preferred provider organization in Jacksonville, Florida and active in the NPI registry since November 2006. The organization lists Tracy Teagle, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1124195573
Entity TypeOrganization
Primary Taxonomy305R00000X
Legal Business NameLAKESHORE MEDICAL CARE CENTER, INC
Location Address4616 SAN JUAN AVEJacksonville, FL 32210-3228
Mailing Address4616 San Juan AveJacksonville, FL 32210-3228 · (904) 384-5385 · Fax (904) 388-5838
Phone(904) 384-5385
Fax(904) 388-5838
Organization SubpartNo
Authorized OfficialTracy TeagleOffice Manager · (904) 384-5385
Enumeration DateNovember 29, 2006
Last NPPES UpdateDecember 27, 2010
✔ NPI 1124195573 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPreferred Provider OrganizationManaged Care Organizations
Taxonomy Code305R00000X
Licenses✔ Licensed in FL · 0042816✔ Licensed in FL · ME0018387
Definition
A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.
4616 SAN JUAN AVE, Jacksonville, FL 32210
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Other Identifiers 2

Medicare ID-Type Unspecified26456FL
Medicare ID-Type Unspecified16859WFL

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 Lakeshore Medical Care Center, Inc's NPI number?

The NPI number for Lakeshore Medical Care Center, Inc is 1124195573. It was assigned to this organization in the NPPES registry on November 29, 2006.

Where is Lakeshore Medical Care Center, Inc located?

Lakeshore Medical Care Center, Inc is located at 4616 San Juan Ave, Jacksonville, FL 32210. The listed phone number is (904) 384-5385.

What is Lakeshore Medical Care Center, Inc's specialty?

The primary specialty registered for this NPI is Preferred Provider Organization with taxonomy code 305R00000X.

When was this NPI record last updated?

The NPPES record for Lakeshore Medical Care Center, Inc was last updated on December 27, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.