LAKE REGIONAL HEALTH SYSTEM (NPI# 1891018784) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891018784 |
| Entity Type | Organization |
| Organization Name | LAKE REGIONAL HEALTH SYSTEM |
| Other Organization Name | LAKE REGIONAL CLINIC - IBERIA |
| Practice Address |
2333 Highway 17 Iberia MO 65486-9331 |
| Mailing Address |
Po Box 1500 Osage Beach MO 65065-1500 |
| Practice Telephone | 5737936900 |
| Practice Fax Number | 5737936688 |
| Mailing Telephone | 5733488074 |
| Mailing Fax Number | 5733488069 |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2015-08-10 |
| Authorized Official Name | 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 | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1891018784 | 05 |
| Other Name | Type Code |
|---|---|
| Lake Regional Clinic - Iberia | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346530797 | Lake Regional Health System | Clinic/Center | 14298 W Us Highway 54, Macks Creek, MO 65786-6730 | 2011-04-19 |
| 1427162254 | Lake Regional Health System | Clinic/Center | 156 Missouri Boulevard, Suite B, Laurie, MO 65038-4933 | 2006-08-18 |
| 1740255520 | Lake Regional Health System | Home Health | 1193 Highway Kk, Ste C, Osage Beach, MO 65065-3344 | 2006-02-23 |
| 1548743412 | Lake Regional Health System | Clinic/Center | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2018-09-07 |
| 1417492091 | Lake Regional Health System | Hospice Care, Community Based | 1193 Highway Kk, Osage Beach, MO 65065-3344 | 2017-01-05 |
| 1962828616 | Lake Regional Health System | Family Medicine | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2014-03-05 |
| 1295151959 | Lake Regional Health System | General Acute Care Hospital | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2014-03-05 |
| 1679997407 | Lake Regional Health System | Durable Medical Equipment & Medical Supplies | 54 Hospital Dr, Suite 201, Osage Beach, MO 65065-3050 | 2014-02-14 |
| 1376883843 | Lake Regional Health System | Durable Medical Equipment & Medical Supplies | 54 Hospital Dr, Osage Beach, MO 65065-3050 | 2013-02-21 |
| 1700177128 | Lake Regional Health System | Clinic/Center | 1870 Bagnell Dam Blvd, Lake Ozark, MO 65049-8658 | 2011-04-20 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LAKE REGIONAL HEALTH SYSTEM | 54 Hospital Dr, Osage Beach, MO 65065-3050 |
| Street Address |
2333 HIGHWAY 17 |
| City | IBERIA |
| State | MO |
| Zip Code | 65486-9331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952300923 | Clemens E. Haggerty | General Practice | 2333 Highway 17, Iberia, MO 65486-9331 | 2005-07-20 |
| 1841749660 | Chelsie Deardeuff | Nurse Practitioner | 2333 Highway 17, Iberia, MO 65486-9331 | 2016-09-22 |
| 1164515029 | Gary N Thomsen | Family Medicine | 2333 Highway 17, Iberia, MO 65486-9331 | 2006-10-02 |
| 1104853050 | Margaret C Hart | Nurse Practitioner | 2333 Highway 17, Iberia, MO 65486 | 2006-06-27 |
| 1821097718 | Robert E Mason | Family Medicine | 2333 Highway 17, Iberia, MO 65486-9331 | 2005-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467571968 | Carl Sylvester Roberts Jr. | Family Medicine | 101e Main St, Iberia, MO 65486 | 2007-03-28 |
| 1093058034 | Medley Pharmacy Inc. | Durable Medical Equipment & Medical Supplies | 2322 Hwy 17, Iberia, MO 65486-0000 | 2013-03-28 |
| 1750402194 | Iberia R-v School District | Local Education Agency (LEA) | 201 Pemberton Dr, Iberia, MO 65486-0156 | 2007-04-03 |
| 1922052091 | Steven Edwin Reenan | Counselor | 986 Highway A, Iberia, MO 65486-8242 | 2006-05-21 |
| 1245660182 | Kyle Nichols | Pharmacist | 2322 Highway 17, Iberia, MO 65486-9115 | 2013-11-13 |
| 1700332020 | Brian Herzog | Music Therapist | 451 Tavern Creek Rd, Iberia, MO 65486-9193 | 2016-08-28 |
| 1396367025 | Rebekah Joy Carlson | Technician | 111 Walkin Rd, Iberia, MO 65486-9700 | 2020-05-15 |
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1144605312 | Nevada City Hospital | Clinic/Center | 627 S Ash St Ste B, Nevada, MO 64772 | 2015-07-29 |
| 1669856829 | Ssm Regional Health Services | Clinic/Center | 2511 W Edgewood Dr Ste F, Jefferson City, MO 65109-5869 | 2015-07-16 |
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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.