LAKE REGIONAL MEDICAL MANAGEMENT, INC. (NPI# 1639134158) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639134158 |
| Entity Type | Organization |
| Organization Name | LAKE REGIONAL MEDICAL MANAGEMENT, INC. |
| Other Organization Name | LAKE REGIONAL MEDICAL GROUP |
| Practice Address |
54 Hospital Dr Osage Beach MO 65065-3050 |
| Mailing Address |
Po Box 1500 Osage Beach MO 65065-1500 |
| Practice Telephone | 5733488074 |
| Practice Fax Number | 5733488069 |
| Mailing Telephone | 5733022840 |
| Mailing Fax Number | 5733022841 |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2015-08-04 |
| Authorized Official Name | MR. DAVID W. HALSELL (SR. V.P. CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 5733488388 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 501945604 | 05 |
| Other Name | Type Code |
|---|---|
| Lake Regional Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780116657 | Lake Regional Medical Management, Inc. | Pharmacy | 416b S Maple St, Eldon, MO 65026-1812 | 2017-03-30 |
| 1407960479 | Lake Regional Medical Management, Inc. | Pharmacy | 1930-c North Business Route 5, Camdenton, MO 65020-2659 | 2006-08-18 |
| 1154701803 | Lake Regional Medical Management, Inc. | Durable Medical Equipment & Medical Supplies | 54 Hospital Dr, Suite 213, Osage Beach, MO 65065-3050 | 2015-06-08 |
| 1609273259 | Lake Regional Medical Management, Inc. | Durable Medical Equipment & Medical Supplies | 1075 Nichols Rd, Suite 7-8, Osage Beach, MO 65065-3093 | 2014-11-25 |
| 1386926939 | Lake Regional Medical Management, Inc. | Durable Medical Equipment & Medical Supplies | 1075 Nichols Rd, Suite 1-2, Osage Beach, MO 65065-3093 | 2011-09-09 |
| 1174814545 | Lake Regional Medical Management, Inc. | Clinic/Center | 5816 Hwy 54, Suite 111, Osage Beach, MO 65065-3046 | 2011-04-20 |
| 1598882656 | Lake Regional Medical Management, Inc. | Durable Medical Equipment & Medical Supplies | 1075 Nichols Rd, Suite 3-4, Osage Beach, MO 65065-3093 | 2007-03-23 |
| Street Address |
54 HOSPITAL DR |
| City | OSAGE BEACH |
| State | MO |
| Zip Code | 65065-3050 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730184151 | Timothy D. Lischwe | Optometrist | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2005-06-14 |
| 1669070298 | Kimberly Jean Farris | Nurse Practitioner | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-10-15 |
| 1437756608 | Barry Keith Hale | Physical Therapy Assistant | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-10-01 |
| 1427664614 | Samantha J Emry | Nurse Practitioner | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-09-22 |
| 1326665688 | Alyssa Heinsohn | Physical Therapist | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-07-02 |
| 1255958138 | Gina Marie Fasano | Orthopaedic Surgery | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-06-26 |
| 1083230718 | Clarice Rose Schmid | Occupational Therapy Assistant | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-06-18 |
| 1093338857 | James Daniel Calkins | Physical Therapy Assistant | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-05-27 |
| 1205476934 | Krystin Nicole Hall | Speech-Language Pathologist | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2020-01-10 |
| 1144868209 | Kristen Kay Lee | Speech-Language Pathologist | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2019-12-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437778859 | Suzanne Marie Harris | Social Worker | 1191 State Highway Kk, Suite 101, Osage Beach, MO 65065 | 2020-04-15 |
| 1982172342 | Arrowhead Retirement Operations LLC | Skilled Nursing Facility | 6100 Arrowhead Drive, Osage Beach, MO 65065 | 2018-11-05 |
| 1245723337 | William T Mcfail | Counselor | 1191 State Hwy Kk, Suite 101, Osage Beach, MO 65065 | 2018-06-13 |
| 1588102263 | Jennifer Kiske | Physical Therapist | 5780 Osage Beach Parkway, Ste 220, Osage Beach, MO 65065 | 2017-02-02 |
| 1700207586 | Brenda Renee Spies | Pharmacist | 4252 Osage Beach Parkway, Osage Beach, MO 65065 | 2013-12-23 |
| 1154668465 | Paige Hedgpath Od, PC | Optometrist | 4645g Osage Beach Parkway, Osage Beach, MO 65065 | 2013-01-07 |
| 1649548330 | Missouri Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 300 Kestrel Lane, Lake Ozark, MO 65065 | 2011-12-08 |
| 1437399821 | Melissa Nicole Morgan | Physical Therapy Assistant | 5177 Vicus Castri, Osage Beach, MO 65065 | 2009-02-25 |
| 1730330911 | Raymond Don Baker | Preventive Medicine | 5476 Stone Ledge Cir, Osage Beach, MO 65065 | 2008-10-06 |
| 1457514259 | Lake Family Dentistry | Dentist | 1037 Palisades Blvd Ste 9, Osage Beach, MO 65065 | 2008-07-02 |
| Find all providers in zip 65065 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982219945 | Behavior Dad, LLC | Clinic/Center | 3509 W Moark, Battlefield, MO 65619-9616 | 2020-09-15 |
| 1801406178 | Primary Care of Cedar Hill Harmony | Clinic/Center | 6420 The Cedars Ct Ste 1, Cedar Hill, MO 63016-2222 | 2020-08-03 |
| 1598373359 | Ozarks Medical Center | Clinic/Center | Omc/zizzer Clinic, 1013 College Street, West Plains, MO 65775 | 2020-07-17 |
| 1447873914 | 2 for Him, LLC | Clinic/Center | 310 Route 66 E, Waynesville, MO 65583-2648 | 2020-05-19 |
| 1780204586 | Keep Well Now | Clinic/Center | 2405 Aspen Rd, Highlandville, MO 65669-8051 | 2020-04-21 |
| 1871112102 | Thrive St. Louis, Inc | Clinic/Center | 4331 Lindell Blvd, Saint Louis, MO 63108-2701 | 2020-04-16 |
| 1548893530 | Gateway Direct Primary Care Jv LLC | Clinic/Center | 1015 Corporate Square Dr Ste 101, Saint Louis, MO 63132-2938 | 2020-02-18 |
| 1033741202 | Olalani Holdings LLC | Clinic/Center | 950 Francis Pl Ste 217, Clayton, MO 63105-2465 | 2020-02-06 |
| 1124659180 | Eldon Family Chiropractic, LLC | Clinic/Center | 102 N Business Highway 54 E Ste D, Eldon, MO 65026-2041 | 2020-01-29 |
| 1619518032 | Mcpherson Medical & Diagnostic, LLC | Clinic/Center | 110 Us Hwy 61 N, Ste B, Hayti, MO 63851 | 2019-10-07 |
| Find all providers with the same taxonomy | ||||
| City | OSAGE BEACH |
| Zip Code | 65065 |
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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.