Healthcare Provider Details

I. General information

NPI: 1295151959
Provider Name (Legal Business Name): LAKE REGIONAL HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US

IV. Provider business mailing address

PO BOX 801661
KANSAS CITY MO
64180-1661
US

V. Phone/Fax

Practice location:
  • Phone: 573-348-8000
  • Fax:
Mailing address:
  • Phone: 573-302-2840
  • Fax: 573-302-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number291-36
License Number StateMO

VIII. Authorized Official

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