MEDICARE: LAKE REGIONAL HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	333600000X	Pharmacy	2001028176	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2048736	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134233109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE REGIONAL HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	PO BOX 1560
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-1560
Country	:	US
Telephone Number	:	573-302-2700
Fax Number	:	573-302-2701

Provider Business Practice Location Address
First Line	:	1057B MEDICAL PARK DR
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3000
Country	:	US
Telephone Number	:	573-302-2700
Fax Number	:	573-302-2701

Authorized Official
Title or Position	:	CFO
Name	:	PAULA SUE LITTLETON
Credential	:
Telephone Number	:	573-348-8388

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	01/07/2025

Similar Medicare Providers

1669718391 — AMERICAN HEALTH INC
Practice Location Address:

LOTE 18 METRO OFFICE PARK , 3RD FLOOR SUITE 3000 AMERICAN HEALTH MEDICARE BUILDING
GUAYNABO, PR
00968

Practice Phone: 787-620-1919
Practice Fax: 787-620-0570

1639026644 — MRS. COURTNEY WOOD
Practice Location Address:

1057 MEDICAL PARK DR BLDG 2
OSAGE BEACH, MO
65065-3000

Practice Phone: 573-302-3100
Practice Fax:

1265420293 — MRS. AMY R LOCKHERT M.D.
Practice Location Address:

1057 MEDICAL PARK DR
OSAGE BEACH, MO
65065-3000

Practice Phone: 573-302-3100
Practice Fax:

1265401285 — DR. MARK W. SHEN D.O.
Practice Location Address:

1057 MEDICAL PARK DR , SUITE A
OSAGE BEACH, MO
65065-3000

Practice Phone: 573-348-2745
Practice Fax: 573-348-8279

1275577926 — DR. RANDALL C BARNES D.O.
Practice Location Address:

1057 MEDICAL PARK DR , SUITE A
OSAGE BEACH, MO
65065-3000

Practice Phone: 573-302-3200
Practice Fax: 573-302-3210

1932201837 — KRISTEN ANNE THEOBALD-HAZEL DO
Practice Location Address:

1057 MEDICAL PARK DR
OSAGE BEACH, MO
65065-3000

Practice Phone: 573-302-3100
Practice Fax: 573-348-8279

Directions to “LAKE REGIONAL HEALTH SYSTEM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.