| Organization Name: | LAKE REGIONAL MEDICAL MANAGEMENT, INC. |
| NPI Number: | 1174814545 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KRISTEN L PRENGER (MANAGED CARE DIRECTOR) |
| Mailing Address: | 5816 Hwy 54 Suite 111 Osage Beach |
| State: | MO US |
| Postal Code: | 650653046 |
| Phone Number: | 5733023200 |
| Fax Number: | 5733023210 |
| NPI Enumeration Date: | 04/20/2011 |
| NPI Last Update Date: | 04/29/2011 |
| 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: | |