| Organization Name: | LAKE REGIONAL HEALTH SYSTEM |
| NPI Number: | 1053427492 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID W. HALSELL (SR. V.P., CHIEF FINANCIAL OFFICER) |
| Mailing Address: | 304a E 4th St Eldon |
| State: | MO US |
| Postal Code: | 650261808 |
| Phone Number: | 5733925654 |
| Fax Number: | 5733925692 |
| NPI Enumeration Date: | 08/21/2006 |
| NPI Last Update Date: | 08/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |