Healthcare Provider Details

I. General information

NPI: 1437440856
Provider Name (Legal Business Name): LAKE REGIONAL HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 N BUSINESS ROUTE 5 UNIT 1A
CAMDENTON MO
65020-2659
US

IV. Provider business mailing address

PO BOX 801661
KANSAS CITY MO
64180-1661
US

V. Phone/Fax

Practice location:
  • Phone: 573-346-5624
  • Fax: 573-346-1957
Mailing address:
  • Phone: 573-348-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MCROBERTS
Title or Position: CEO
Credential:
Phone: 573-348-8756