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LAKESIDE MEDICAL WELLNESS CLINIC
NPI 1407147234
Clinic/Center in Sulphur, LA

Active since April 27, 2011
1908 MAPLEWOOD DR, SUITE B, SULPHUR, LA 70663(337) 625-5050(337) 625-6726 Get Directions Write a Review

NPPES record last updated: April 27, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lakeside Medical Wellness Clinic NPPES

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

LAKESIDE MEDICAL WELLNESS CLINIC (NPI 1407147234) is a healthcare organization registered as a clinic/center in Sulphur, Louisiana and active in the NPI registry since April 2011. The organization lists Stacy W Kirkum, Administrator, as its authorized official.

NPPES Registry Identity

NPI1407147234
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameLAKESIDE MEDICAL WELLNESS CLINIC
Location Address1908 MAPLEWOOD DR, SUITE BSulphur, LA 70663-6000
Mailing Address1908 Maplewood Dr, Suite BSulphur, LA 70663-6000 · (337) 625-5050 · Fax (337) 625-6726
Phone(337) 625-5050
Fax(337) 625-6726
Organization SubpartNo
Authorized OfficialStacy W KirkumAdministrator · (337) 625-5050
Enumeration DateApril 27, 2011
✔ NPI 1407147234 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in LA · MD14484R
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
1908 MAPLEWOOD DR, Sulphur, LA 70663
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Other Identifiers 2

Medicaid1476269LA
Medicare UPINC30934LA

Other Providers at the Same Location NPPES

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

PAUL GREGORY LANCON DC
Chiropractor
1908 MAPLEWOOD DR, SUITE A
SULPHUR, LA 70663
Calcasieu Parish (337) 533-8750

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 Medical Wellness Clinic's NPI number?

The NPI number for Lakeside Medical Wellness Clinic is 1407147234. It was assigned to this organization in the NPPES registry on April 27, 2011.

Where is Lakeside Medical Wellness Clinic located?

Lakeside Medical Wellness Clinic is located at 1908 Maplewood Dr Suite B, Sulphur, LA 70663. The listed phone number is (337) 625-5050.

What is Lakeside Medical Wellness Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

When was this NPI record last updated?

The NPPES record for Lakeside Medical Wellness Clinic was last updated on April 27, 2011. 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.