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LAKE REGIONAL MEDICAL MANAGEMENT INC. NPI 1639134158


NPI Information

NPI: 1639134158
Provider Name: LAKE REGIONAL MEDICAL MANAGEMENT, INC.

Doing Business As: LAKE REGIONAL MEDICAL GROUP

Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
54 HOSPITAL DR
OSAGE BEACH, MO
ZIP 65065
Phone: (573) 348-8074
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LAKE REGIONAL MEDICAL MANAGEMENT, INC. is a clinic center in Osage Beach, MO. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). LAKE REGIONAL MEDICAL MANAGEMENT, INC. NPI is 1639134158. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Regional Medical Group.

The provider's business location address is:

54 HOSPITAL DR
OSAGE BEACH, MO
ZIP 65065-050
Phone: (573) 348-8074
Fax: (573) 348-8069

The provider's authorized official is Kevin Mcroberts .
The authorized official title is Ceo and has the following contact phone number (573) 348-8756.

The enumeration date for this NPI number is 4/18/2006 and was last updated on 10/16/2023.


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
1261Q00000XClinic/CenterYes

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
1501945604MEDICAIDMISSOURI

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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