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LAKESIDE FAMILY MEDICINE
NPI 1295064178
Family Medicine in Kingston, OK

Active since December 23, 2009CLIA 37D2000831 · Waiver
21 N. MAIN STREET, KINGSTON, OK 73439(580) 226-1010 Get Directions Write a Review

NPPES record last updated: December 23, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Lakeside Family Medicine NPPES

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

LAKESIDE FAMILY MEDICINE (NPI 1295064178) is a healthcare organization registered as a family medicine in Kingston, Oklahoma and active in the NPI registry since December 2009. The organization holds a CLIA Waiver certificate valid through September 3, 2026 and lists Pamela E Ahearn, Owner/president, as its authorized official.

NPPES Registry Identity

NPI1295064178
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameLAKESIDE FAMILY MEDICINE
Location Address21 N. MAIN STREETKingston, OK 73439-1798
Mailing AddressPo Box 1798Kingston, OK 73439-1798 · (580) 226-1010
Phone(580) 226-1010
Organization SubpartNo
Authorized OfficialPamela E AhearnOwner/president · (580) 226-1010
Enumeration DateDecember 23, 2009
✔ NPI 1295064178 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in OK · 19862
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
21 N. MAIN STREET, Kingston, OK 73439
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Other Identifiers 2

MedicaidPENDINGOK
Medicare PINPENDINGOK

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.Insurance ›

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 37D2000831

Lakeside Family Medicine · Kingston, OK
Active · expires Sep 3, 2026
CLIA Number37D2000831
Laboratory TypePhysician Office
Certificate Effective DateSeptember 4, 2024
Certificate Expiration DateSeptember 3, 2026
Laboratory DirectorPamela E. Ahearn
Laboratory Phone(580) 795-4640
Laboratory LocationLakeside Family Medicine714 Highway 70 East, Kingston, OK 73439
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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 Family Medicine's NPI number?

The NPI number for Lakeside Family Medicine is 1295064178. It was assigned to this organization in the NPPES registry on December 23, 2009.

Where is Lakeside Family Medicine located?

Lakeside Family Medicine is located at 21 N. Main Street, Kingston, OK 73439. The listed phone number is (580) 226-1010.

What is Lakeside Family Medicine's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Lakeside Family Medicine hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 37D2000831) is associated with this NPI, valid through September 3, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Lakeside Family Medicine accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 1 other insurer list Lakeside Family Medicine as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lakeside Family Medicine was last updated on December 23, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.