Healthcare Provider Details

I. General information

NPI: 1578125324
Provider Name (Legal Business Name): LAKE REGIONAL HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 09/02/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 COWAN DR
LEBANON MO
65536-4629
US

IV. Provider business mailing address

PO BOX 801661
KANSAS CITY MO
64180-1661
US

V. Phone/Fax

Practice location:
  • Phone: 573-302-3990
  • Fax: 573-302-2753
Mailing address:
  • Phone: 573-348-8391
  • Fax: 573-348-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PAULA SUE LITTLETON
Title or Position: CFO
Credential:
Phone: 573-348-8388