Provider Demographics
NPI:1205819356
Name:LAKEVIEW COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:LAKEVIEW COMMUNITY HOSPITAL
Other - Org Name:LAKEVIEW FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT-PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUXSER
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:269-657-0243
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-0178
Mailing Address - Country:US
Mailing Address - Phone:269-657-2550
Mailing Address - Fax:269-657-2285
Practice Address - Street 1:404 HAZEN STREET
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-0178
Practice Address - Country:US
Practice Address - Phone:269-657-2550
Practice Address - Fax:269-657-2285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
238600OtherRHC-LAWTON
238601OtherRHC-PAW PAW
238600OtherRHC-LAWTON
OHO6014Medicare ID - Type Unspecified