Provider Demographics
NPI:1174417240
Name:LAKEWAY ERA ACQUISTION PARTNERS LLC
Entity type:Organization
Organization Name:LAKEWAY ERA ACQUISTION PARTNERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-591-2256
Mailing Address - Street 1:PO BOX 92756
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0756
Mailing Address - Country:US
Mailing Address - Phone:817-421-0012
Mailing Address - Fax:817-421-0036
Practice Address - Street 1:1518 RANCH ROAD 620 S STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6429
Practice Address - Country:US
Practice Address - Phone:512-524-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care