Healthcare Provider Details

I. General information

NPI: 1215194907
Provider Name (Legal Business Name): LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N MAIN ST
RICE LAKE WI
54868-1238
US

IV. Provider business mailing address

1100 N MAIN ST
RICE LAKE WI
54868-1238
US

V. Phone/Fax

Practice location:
  • Phone: 715-234-1515
  • Fax: 715-234-4465
Mailing address:
  • Phone: 715-234-1515
  • Fax: 715-234-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1562800
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1562800
License Number StateWI

VIII. Authorized Official

Name: MS. JACQUELINE KLEIN
Title or Position: CFO
Credential:
Phone: 715-236-6129