MEDICARE: LAKEWOOD 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
1	261QR1300X	Rural Health Clinic/Center		MN

General Provider Information

NPI Number	:	1912998089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	49725 COUNTY 83
Second Line	:
City	:	STAPLES
State	:	MN
Zip	:	56479-5280
Country	:	US
Telephone Number	:	218-894-1515
Fax Number	:	218-898-7596

Provider Business Practice Location Address
First Line	:	1233 HIGHWAY 10 S
Second Line	:
City	:	MOTLEY
State	:	MN
Zip	:	56466-8209
Country	:	US
Telephone Number	:	218-352-6922
Fax Number	:	218-898-7594

Authorized Official
Title or Position	:	CFO
Name	:	JOSEPH T REYCRAFT
Credential	:
Telephone Number	:	218-894-8194

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	06/09/2025

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Directions to “LAKEWOOD HEALTH SYSTEM ” Practice Location

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