Basic Information
Provider Information | |||||||||
NPI: | 1427011402 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LAKES REGIONAL HEALTHCARE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX AB | ||||||||
Address2: |   | ||||||||
City: | SPIRIT LAKE | ||||||||
State: | IA | ||||||||
PostalCode: | 513600159 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7123361230 | ||||||||
FaxNumber: | 7123368620 | ||||||||
Practice Location | |||||||||
Address1: | 2301 HIGHWAY 71 | ||||||||
Address2: |   | ||||||||
City: | SPIRIT LAKE | ||||||||
State: | IA | ||||||||
PostalCode: | 513601184 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7123361230 | ||||||||
FaxNumber: | 7123368620 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/10/2006 | ||||||||
LastUpdateDate: | 09/18/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ALGER | ||||||||
AuthorizedOfficialFirstName: | STEVE | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | SR VP AND CFO | ||||||||
AuthorizedOfficialTelephone: | 7123368796 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 300028H | IA | Y |   | Hospital Units | Medicare Defined Swing Bed Unit |   |
No ID Information.