Provider Demographics
NPI:1003850868
Name:LAKELAND HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:LAKELAND HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SWIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-512-1551
Mailing Address - Street 1:10600 OLD COUNTY ROAD 15 # 140
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6200
Mailing Address - Country:US
Mailing Address - Phone:763-512-1551
Mailing Address - Fax:
Practice Address - Street 1:10600 OLD COUNTY ROAD 15 # 140
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6200
Practice Address - Country:US
Practice Address - Phone:763-512-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QS1200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000012130Medicare PIN
MN4526570001Medicare NSC
MNP00165449Medicare PIN
MN470000049Medicare PIN