Organization Name: | LAKE REGIONAL HEALTH SYSTEM |
NPI Number: | 1245520691 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID W. HALSELL (SR. V.P., CHIEF FINANCIAL OFFICER) |
Mailing Address: | 1057 Medical Park Dr Suite A Osage Beach |
State: | MO US |
Postal Code: | 650653000 |
Phone Number: | 5733023100 |
Fax Number: | 5733488279 |
NPI Enumeration Date: | 04/19/2011 |
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: |