Provider Demographics
NPI:1285793240
Name:LAKESIDE BIRTH CENTER LLC
Entity type:Organization
Organization Name:LAKESIDE BIRTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:253-862-6533
Mailing Address - Street 1:2722 214 AVE EAST
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6245
Mailing Address - Country:US
Mailing Address - Phone:253-862-6533
Mailing Address - Fax:253-862-1840
Practice Address - Street 1:2722 214 AVE EAST
Practice Address - Street 2:
Practice Address - City:LAKE TAPPS
Practice Address - State:WA
Practice Address - Zip Code:98391-6245
Practice Address - Country:US
Practice Address - Phone:253-862-6533
Practice Address - Fax:253-862-1840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7060452Medicaid