Healthcare Provider Details

I. General information

NPI: 1093670630
Provider Name (Legal Business Name): LAKELAND HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SHERMAN ST STE 450
SAINT PAUL MN
55102-2562
US

IV. Provider business mailing address

10600 OLD COUNTY ROAD 15 STE 140
PLYMOUTH MN
55441-6201
US

V. Phone/Fax

Practice location:
  • Phone: 651-641-7100
  • Fax:
Mailing address:
  • Phone: 763-354-7648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEORGE OMAE
Title or Position: CEO & PRESIDENT
Credential:
Phone: 763-354-7648