LAKE REGIONAL HEALTH SYSTEM NPI 1386311223

NPI Information

NPI: 1386311223
Provider Name: LAKE REGIONAL HEALTH SYSTEM

Doing Business As: LAKE REGIONAL CLINIC-LEBANON

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
755 COWAN DRIVE
LEBANON, MO
ZIP 65536
Phone: (417) 532-2805
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LAKE REGIONAL HEALTH SYSTEM is a rural health clinic center in Lebanon, MO. LAKE REGIONAL HEALTH SYSTEM NPI is 1386311223. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Regional Clinic-lebanon.

The provider's business location address is:

755 COWAN DRIVE
LEBANON, MO
ZIP 65536
Phone: (417) 532-2805
Fax: (417) 532-2848

The provider's authorized official is Kevin Mcroberts .
The authorized official title is Ceo and has the following contact phone number (573) 348-8388.

The CLIA number assigned to this NPI record is 26D2153734 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/27/2021 and was last updated on 10/12/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	590107490	MEDICAID	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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