Healthcare Provider Details

I. General information

NPI: 1023067642
Provider Name (Legal Business Name): LAKE VIEW MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 11TH AVE
TWO HARBORS MN
55616-1300
US

IV. Provider business mailing address

29980 NETWORK PL
CHICAGO IL
60673-1299
US

V. Phone/Fax

Practice location:
  • Phone: 218-834-7300
  • Fax: 218-834-7388
Mailing address:
  • Phone: 218-834-7300
  • Fax: 218-834-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number331064
License Number StateMN

VIII. Authorized Official

Name: LORI PECK
Title or Position: SVP- CHIEF FINANCIAL OFFICER
Credential:
Phone: 715-847-2575