MAYO CLINIC HEALTH SYSTEM-LAKE CITY (NPI# 1447863972) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447863972 |
| Entity Type | Organization |
| Organization Name | MAYO CLINIC HEALTH SYSTEM-LAKE CITY |
| Practice Address |
500 W Grant St Lake City MN 55041-1143 |
| Practice Telephone | 6513453321 |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2020-08-25 |
| Authorized Official Name | PRAVEEN MEKALA (CFO) |
| Authorized Official Telephone | 5072661557 |
| Is Organization Subpart | Y |
| Parent Organization Name | MAYO CLINIC HEALTH SYSTEM-LAKE CITY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891710893 | Mayo Clinic Health System-lake City | Medicare Defined Swing Bed Unit | 500 W Grant St, Lake City, MN 55041-1143 | 2006-07-12 |
| 1164463659 | Mayo Clinic Health System-lake City | Clinic/Center | 500 W Grant St, Lake City, MN 55041-1143 | 2006-06-08 |
| 1831130319 | Mayo Clinic Health System-lake City | Skilled Nursing Facility | 500 W Grant St, Lake City, MN 55041-1143 | 2006-06-08 |
| 1538113022 | Mayo Clinic Health System-lake City | General Acute Care Hospital | 500 W Grant St, Lake City, MN 55041-1143 | 2006-05-20 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MAYO CLINIC HEALTH SYSTEM-LAKE CITY | 500 West Grant St, Lake City, MN 55041-1143 |
| Street Address |
500 W GRANT ST |
| City | LAKE CITY |
| State | MN |
| Zip Code | 55041-1143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689650350 | Ann Marie Lowe | Family Medicine | 500 W Grant St, Lake City, MN 55041-1143 | 2005-12-15 |
| 1689280406 | Kelly Marie Kennedy | Pharmacist | 500 W Grant St, Lake City, MN 55041-1143 | 2020-09-17 |
| 1124638341 | Rebekah Richter | Physical Therapist | 500 W Grant St, Lake City, MN 55041-1143 | 2020-08-03 |
| 1225661416 | Patricia Elena Servin-hughes | Nurse Practitioner | 500 W Grant St, Lake City, MN 55041-1143 | 2020-02-17 |
| 1598318016 | Shannon Campbell | Physical Therapist | 500 W Grant St, Lake City, MN 55041-1143 | 2019-07-23 |
| 1861965774 | Cole James Kriett | Physician Assistant | 500 W Grant St, Lake City, MN 55041-1143 | 2019-01-03 |
| 1992217673 | Tina Marie Montgomery | Speech-Language Pathologist | 500 W Grant St, Lake City, MN 55041-1143 | 2017-11-02 |
| 1972015923 | Heather Nagel | Physical Therapist | 500 W Grant St, Lake City, MN 55041-1143 | 2017-10-31 |
| 1821500265 | Simone Leanne Lenertz | Occupational Therapist | 500 W Grant St, Lake City, MN 55041-1143 | 2017-10-25 |
| 1629580071 | Kelly Rehder | Physical Therapist | 500 W Grant St, Lake City, MN 55041-1143 | 2017-10-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285136242 | Perry Dental, Ltd. | Dentist | 210 N. Lakeshore Dr., Lake City, MN 55041 | 2018-03-06 |
| 1790182335 | Innovative Chiropractic Center | Chiropractor | 201 D East Ave., Red Wing, MN 55041 | 2014-11-25 |
| 1245327147 | David F Valkos | Chiropractor | 106 So Washington St, Lake City, MN 55041 | 2006-10-10 |
| 1063441830 | Michael D Ackermann | Optometrist | 117 W Center St, Lake City, MN 55041 | 2006-07-02 |
| 1760668693 | Elizabeth Agnes Olson | Chiropractor | 106 S Washington St, Lake City, MN 55041-1034 | 2008-01-10 |
| 1194900936 | Valkos Chiropractic Office, LLC | Clinic/Center | 106 S Washington St, Lake City, MN 55041-1034 | 2007-12-28 |
| 1417333428 | River Oaks At Lake Pepin, LLC. | Home Health | 815 N High St, Lake City, MN 55041-1225 | 2015-08-03 |
| 1124189444 | Stephen Lee Brown | Dentist | 1350 N 7th St, Lake City, MN 55041-1251 | 2006-12-12 |
| 1114188307 | Pepin Valley Dental | Clinic/Center | 1350 N 7th St, Lake City, MN 55041-1251 | 2008-06-19 |
| 1366627564 | Lesa Ann Funke | Dental Hygienist | 1350 N 7th St, Lake City, MN 55041-1251 | 2008-01-07 |
| Find all providers in zip 55041 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487942157 | Live Oak Medical Center | Non-Pharmacy Dispensing Site | 148 Sauls St, Lake City, SC 29560-2631 | 2011-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518528397 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | Fairview Lakeville Clinic Mtm, 18580 Joplin Ave, Lakeville, MN 55044 | 2019-06-24 |
| 1851856504 | Tareen Dermatology, Pa | Non-Pharmacy Dispensing Site | 2945 Hazelwood St Ste 230, Maplewood, MN 55109-1241 | 2019-02-07 |
| 1417450651 | Cerner Health Connections, Inc | Non-Pharmacy Dispensing Site | 4001 Lexington Ave N Ste C2-435, Arden Hills, MN 55126-2934 | 2018-03-14 |
| 1316461593 | Fairview Pharmacy Service LLC | Non-Pharmacy Dispensing Site | 7250 France Ave S Ste 410, Edina, MN 55435-4314 | 2017-07-31 |
| 1346653052 | Advanced Spine and Pain Clinics of Mn, LLC | Non-Pharmacy Dispensing Site | 308 Brighton Ave, Suite D, Buffalo, MN 55313-2303 | 2014-06-10 |
| 1407296148 | Group Health Plan Inc | Non-Pharmacy Dispensing Site | 1833 2nd Ave, Anoka, MN 55303-2432 | 2013-06-26 |
| 1295178135 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 6440 Nicollet Ave South, Richfield, MN 55423-1613 | 2013-04-10 |
| 1992148845 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 2450 Riverside Ave South, Minneapolis, MN 55454-1400 | 2013-04-10 |
| 1083984876 | Mayo Clinic Health System-southeast Minnesota Region | Non-Pharmacy Dispensing Site | 32021 County 24 Boulevard, Cannon Falls, MN 55009-1824 | 2012-01-10 |
| 1255623765 | Mankato Clinic, Ltd | Non-Pharmacy Dispensing Site | 305 Main St Ne, Mapleton, MN 56065 | 2011-05-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.