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General NPI Number Information
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NPI Number | 1659511335
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Entity Type | Organization
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Legal Business Name | LAKEWOOD HEALTH CENTER
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 600 MAIN AVE S
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City | BAUDETTE
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State | MN
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Zip | 56623-2855
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Country | US
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Telephone | 218-634-1655
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Fax | 218-634-1094
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Provider Business Mailing Address
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Address Line | 600 MAIN AVE S
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City | BAUDETTE
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State | MN
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Zip | 56623-2855
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Country | US
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Telephone | 218-634-1655
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Fax | 218-634-1094
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFRY A STAMPOHAR
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Credential |
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Telephone | 218-634-2120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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