Basic Information
| Provider Information | |||||||||
| NPI: | 1356448542 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKE COUNTY ACUTE CARE, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 CORPORATE BLVD | ||||||||
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| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705083870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008939698 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 E ROLLINS RD | ||||||||
| Address2: | |||||||||
| City: | ROUND LAKE BEACH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600733808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477402500 | ||||||||
| FaxNumber: | 8477402505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | LIPSMEYER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3376091221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 04/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1356448542 | 05 | IL | MEDICAID | 0004932642 | 01 | IL | BCBS | OTHER | DF3775 | 01 | IL | RR MCR | OTHER |