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General NPI Number Information
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NPI Number | 1790781235
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Entity Type | Organization
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Legal Business Name | LAKE REGION BONE & JOINT SURGEONS
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 3807 GREENLEAF AVE NW
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City | BEMIDJI
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State | MN
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Zip | 56601-5817
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Country | US
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Telephone | 218-751-9746
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Fax | 218-759-0620
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Provider Business Mailing Address
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Address Line | 3807 GREENLEAF AVE NW
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City | BEMIDJI
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State | MN
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Zip | 56601-5817
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Country | US
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Telephone | 218-751-9746
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Fax | 218-759-0620
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Authorized Official
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Title or Position | CLAIMS MGR
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Name | MS. RITA DREWS
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Credential |
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Telephone | 218-751-9746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1290
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License Number State | MN
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