Provider Demographics
NPI:1093713372
Name:LAKE REGION HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:LAKE REGION HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-736-8000
Mailing Address - Street 1:712 S CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2913
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:218-736-8775
Practice Address - Street 1:712 S CASCADE ST
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2913
Practice Address - Country:US
Practice Address - Phone:218-736-8000
Practice Address - Fax:218-736-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN327293273R00000X, 273Y00000X, 282N00000X
MN327090314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN510847100Medicaid
MN316714300Medicaid
MN1637ELAOtherBLUE CROSS
MN1637HLAOtherBLUE CROSS
MN510847101Medicaid
MN510847167Medicaid
MN60685LAOtherBLUE CROSS
MN316714300Medicaid
MN1637ELAOtherBLUE CROSS
MN510847100Medicaid
MN1637HLAOtherBLUE CROSS
MN245162Medicare ID - Type Unspecified
MN0658300001Medicare ID - Type Unspecified
MN247196Medicare ID - Type Unspecified