Lakeshore Pediatrics of Russellville
NPI 1194907394ActiveOrganization· Pediatrics· Russellville, AL
Pediatrics in Russellville, Alabama, registered in NPPES in November 2007. The authorized official on file is Agustin Rivas, M.D., Owner.
Overview
| NPI | 1194907394 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 29, 2007 |
| Last updated in NPPES | Nov 29, 2007 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pediatrics Primary | 208000000X | 2006323 | AL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Pediatrics providers in Russellville
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