Healthcare Provider Details

I. General information

NPI: 1972799237
Provider Name (Legal Business Name): LAKEWOOD HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAIN AVE S
BAUDETTE MN
56623-2855
US

IV. Provider business mailing address

600 MAIN AVE S
BAUDETTE MN
56623-2855
US

V. Phone/Fax

Practice location:
  • Phone: 218-634-1655
  • Fax: 218-634-1094
Mailing address:
  • Phone: 218-634-1655
  • Fax: 218-634-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFRY A STAMPOHAR
Title or Position: PRESIDENT
Credential:
Phone: 218-634-2120