Provider Demographics
NPI:1972803898
Name:LAKEVIEW SURGERY CENTER, LLC
Entity type:Organization
Organization Name:LAKEVIEW SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-971-4001
Mailing Address - Street 1:100 JIM MASON CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8965
Mailing Address - Country:US
Mailing Address - Phone:478-971-4001
Mailing Address - Fax:478-971-4004
Practice Address - Street 1:100 JIM MASON CT
Practice Address - Street 2:SUITE B
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8965
Practice Address - Country:US
Practice Address - Phone:478-971-4001
Practice Address - Fax:478-971-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076-442261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G495488Medicare PIN