LAKES AREA HEALTH CENTER, PLLC (NPI# 1467403030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467403030 |
| Entity Type | Organization |
| Organization Name | LAKES AREA HEALTH CENTER, PLLC |
| Other Organization Name | OTTOMEYER CLINICS, PLLC |
| Practice Address |
967 Lake St S Forest Lake MN 55025 |
| Mailing Address |
967 Lake St S Forest Lake MN 55025-2616 |
| Practice Telephone | 6514641113 |
| Practice Fax Number | 6514640853 |
| Mailing Telephone | 6514641113 |
| Mailing Fax Number | 6514640853 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2018-06-18 |
| Authorized Official Name | RICHARD VINCENT OTTOMEYER (CEO OWNER) |
| Authorized Official Telephone | 6514641113 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
24-6599 | MN | Ambulatory Health Care Facilities |
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Ottomeyer Clinics | Doing Business As Name - Organization |
| Ottomeyer Clinics, PLLC | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 360 Sherman St Ste 400, Saint Paul, MN 551022425 | 6512251102 | 6129771208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851887780 | Lakes Area Health Center, Pllc | Physical Therapist | 360 Sherman St Ste 400, Saint Paul, MN 55102-2425 | 2018-07-03 |
| 1578059408 | Lakes Area Health Center, Pllc | Physical Therapist | 8232 Highway 65 Ne, Spring Lake Park, MN 55432-2095 | 2018-07-03 |
| 1467948398 | Lakes Area Health Center, Pllc | General Practice | 8232 Highway 65 Ne, Spring Lake Park, MN 55432-2095 | 2018-07-03 |
| 1902392830 | Lakes Area Health Center, Pllc | General Practice | 360 Sherman St Ste 400, Saint Paul, MN 55102-2425 | 2018-07-03 |
| Street Address |
967 LAKE ST S |
| City | FOREST LAKE |
| State | MN |
| Zip Code | 55025 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356338339 | Brenda Lee Fandel | Chiropractor | 967 Lake St S, Forest Lake, MN 55025-2616 | 2005-10-04 |
| 1821400631 | Lisa Marie Forslund | Nurse Practitioner | 967 Lake St S, Forest Lake, MN 55025-2616 | 2014-05-28 |
| 1639461544 | James Walter Chapman | Chiropractor | 967 Lake St S, Forest Lake, MN 55025-2616 | 2011-05-11 |
| 1841522166 | Vladimir Joseph Scharafanow | Massage Therapist | 967 Lake St S, Forest Lake, MN 55025-2616 | 2010-02-11 |
| 1407187511 | Janice Lee James | Nurse Practitioner | 967 Lake St S, Forest Lake, MN 55025-2616 | 2010-01-29 |
| 1194992131 | Daniel Philip Piper | Chiropractor | 967 Lake St S, Forest Lake, MN 55025-2616 | 2008-05-09 |
| 1588749642 | Donald Wayne Kjome | Family Medicine | 967 Lake St S, Forest Lake, MN 55025-2616 | 2006-10-26 |
| 1720097389 | Deborah S Korbitz | Nurse Practitioner | 967 Lake St S, Forest Lake, MN 55025 | 2006-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043846173 | Persistence Physical Therapy LLC | Clinic/Center | 2009 W Broadway Ave, Ste 400 Pmb 131, Forest Lake, MN 55025 | 2020-03-20 |
| 1255973319 | Connie Rettig | Technician | 908 North Shore Drive, Forest Lake, MN 55025 | 2019-10-10 |
| 1003394479 | Malissa Ann Costanzo | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 844 8th Ave Se, Forest Lake, MN 55025 | 2018-07-30 |
| 1669754735 | Brent Alan Millard | Pharmacist | 1207 West Broadway Ave, Forest Lake, MN 55025 | 2011-09-15 |
| 1982842167 | Lakes Center for Youth and Families | Community/Behavioral Health | 20 N Lake Street, Suite 103, Forest Lake, MN 55025 | 2009-01-27 |
| 1487843355 | Paul Luke Mladnick | Marriage & Family Therapist | 1068 So Lake St, #109, Forest Lake, MN 55025 | 2007-10-17 |
| 1740477678 | Rita Lynn Scanlan | Occupational Therapist | 604 Ne 1st St, Birchwood Health Care Center, Forest Lake, MN 55025 | 2007-09-25 |
| 1114053113 | Senior Care Forest Lake, LLC | Skilled Nursing Facility | 604 N.e. First Street, Forest Lake, MN 55025 | 2007-02-26 |
| 1073672101 | Catharine B Ruther | Dentist | 956 West Broadway, Lakes Dental Clinic, Forest Lake, MN 55025 | 2006-12-06 |
| 1407914849 | Ervin George Savord | Dentist | 255 Highway 97, Suite 1b, Forest Lake, MN 55025 | 2006-12-05 |
| Find all providers in zip 55025 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 1992224331 | Orthopedic & Sports Physical Therapy, Inc. | Clinic/Center | 322 N Tower Rd, Fergus Falls, MN 56537-1015 | 2017-09-18 |
| 1003339789 | Centracare Clinic | Clinic/Center | 2025 Stearns Way Ste 114, Saint Cloud, MN 56303 | 2017-07-25 |
| Find all providers with the same taxonomy | ||||
| City | FOREST LAKE |
| Zip Code | 55025 |
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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.