MEDICARE: LAKES REGIONAL HEALTHCARE

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	282N00000X	General Acute Care Hospital	300028H	IA

Other Identifiers

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

General Provider Information

NPI Number	:	1508862012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKES REGIONAL HEALTHCARE

Provider Business Mailing Address
First Line	:	PO BOX AB
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-0159
Country	:	US
Telephone Number	:	712-336-1230
Fax Number	:	712-336-8620

Provider Business Practice Location Address
First Line	:	2301 HIGHWAY 71
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-1184
Country	:	US
Telephone Number	:	712-336-1230
Fax Number	:	712-336-8620

Authorized Official
Title or Position	:	SR VP AND CFO
Name	:	MR. STEVE J ALGER
Credential	:
Telephone Number	:	712-336-8796

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	09/19/2012

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