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LAKE GRANBURY INTERNAL MEDICINE & PEDIATRICS, PA
NPI 1972608636
Internal Medicine in Granbury, TX

Active since September 14, 2006CLIA 45D1064926 · Microscopy
2005 ROCKVIEW DRIVE, GRANBURY, TX 76049(817) 579-1005(817) 579-1093 Get Directions Write a Review

NPPES record last updated: April 2, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Lake Granbury Internal Medicine & Pediatrics, Pa NPPES

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

LAKE GRANBURY INTERNAL MEDICINE & PEDIATRICS, PA (NPI 1972608636) is a healthcare organization registered as an internal medicine in Granbury, Texas and active in the NPI registry since September 2006. The organization holds a CLIA Microscopy certificate valid through February 14, 2027 and lists Penelope A. Jackson, Physician/owner, as its authorized official.

NPPES Registry Identity

NPI1972608636
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameLAKE GRANBURY INTERNAL MEDICINE & PEDIATRICS, PA
Location Address2005 ROCKVIEW DRIVEGranbury, TX 76049
Mailing Address2005 Rockview DriveGranbury, TX 76049 · (817) 579-1005 · Fax (817) 579-1093
Phone(817) 579-1005
Fax(817) 579-1093
Organization SubpartNo
Authorized OfficialPenelope A. JacksonPhysician/owner · (817) 579-1005
Enumeration DateSeptember 14, 2006
Last NPPES UpdateApril 2, 2014
✔ NPI 1972608636 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedPediatricsTaxonomy 208000000X
2005 ROCKVIEW DRIVE, Granbury, TX 76049
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-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 for Provider-Performed Microscopy Procedures (PPMP) 45D1064926

Lake Granbury Internal Medicine · Granbury, TX
Active · expires Feb 14, 2027
CLIA Number45D1064926
Laboratory TypePhysician Office
Certificate Effective DateFebruary 15, 2025
Certificate Expiration DateFebruary 14, 2027
Laboratory DirectorPenelope A. Jackson
Laboratory Phone(817) 579-1005
Laboratory LocationLake Granbury Internal Medicine2005 Rockview Dr, Granbury, TX 76049
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

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

DR. PENELOPE AIKIN JACKSON M.D.
Internal Medicine
2005 ROCKVIEW DRIVE
GRANBURY, TX 76049
Hood County (817) 579-1005

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 Lake Granbury Internal Medicine & Pediatrics, PA's NPI number?

The NPI number for Lake Granbury Internal Medicine & Pediatrics, PA is 1972608636. It was assigned to this organization in the NPPES registry on September 14, 2006.

Where is Lake Granbury Internal Medicine & Pediatrics, PA located?

Lake Granbury Internal Medicine & Pediatrics, PA is located at 2005 Rockview Drive, Granbury, TX 76049. The listed phone number is (817) 579-1005.

What is Lake Granbury Internal Medicine & Pediatrics, PA's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Lake Granbury Internal Medicine & Pediatrics, PA hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 45D1064926) is associated with this NPI, valid through February 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lake Granbury Internal Medicine & Pediatrics, PA was last updated on April 2, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.