Provider Demographics
NPI:1124450366
Name:LAKEWOOD MEDICAL CENTER CORPORATION
Entity type:Organization
Organization Name:LAKEWOOD MEDICAL CENTER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAI
Authorized Official - Middle Name:PHONG
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-238-1488
Mailing Address - Street 1:1700 WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5256
Mailing Address - Country:US
Mailing Address - Phone:303-238-1488
Mailing Address - Fax:303-238-1459
Practice Address - Street 1:1700 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5256
Practice Address - Country:US
Practice Address - Phone:303-238-1488
Practice Address - Fax:303-238-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization