Provider Demographics
NPI:1235432808
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:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
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 STE 140
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6201
Mailing Address - Country:US
Mailing Address - Phone:763-354-7647
Mailing Address - Fax:
Practice Address - Street 1:622 ROOSEVELT RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-6153
Practice Address - Country:US
Practice Address - Phone:320-253-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2020-04-16
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
MN470000083Medicare UPIN
MN4526570001Medicare NSC