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NPI Code Detail

MEDICARE: LAKE REGIONAL HEALTH SYSTEM

MEDICARE: LAKE REGIONAL HEALTH SYSTEM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR1300XRural Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053427492
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE REGIONAL HEALTH SYSTEM
Provider Business Mailing Address
First Line : PO BOX 801661
Second Line :
City : KANSAS CITY
State : MO
Zip : 64180-1500
Country : US
Telephone Number : 573-348-8000
Fax Number :
Provider Business Practice Location Address
First Line : 304A E 4TH ST
Second Line :
City : ELDON
State : MO
Zip : 65026-1808
Country : US
Telephone Number : 573-392-5654
Fax Number : 573-392-5692
Authorized Official
Title or Position : CEO
Name : KEVIN MCROBERTS
Credential :
Telephone Number : 573-348-8756
Provider Enumeration Date : 08/21/2006
Last Update Date : 10/12/2023

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Directions to “LAKE REGIONAL HEALTH SYSTEM ” Practice Location

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