Provider Demographics
NPI:1336291160
Name:LAKES REGIONAL HEALTHCARE
Entity Type:Organization
Organization Name:LAKES REGIONAL HEALTHCARE
Other - Org Name:NORTHWEST IOWA EMERGENCY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-336-8796
Mailing Address - Street 1:2301 HIGHWAY 71 SOUTH
Mailing Address - Street 2:PO BOX AB
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-0159
Mailing Address - Country:US
Mailing Address - Phone:712-336-1230
Mailing Address - Fax:712-336-8634
Practice Address - Street 1:2301 HIGHWAY 71 SOUTH
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360
Practice Address - Country:US
Practice Address - Phone:712-336-1230
Practice Address - Fax:712-336-8634
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKES REGIONAL HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA300028H207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0250738Medicaid
IA19398NWOtherBCBS MN GROUP PHYSICIAN
IA25073OtherBCBS IA GROUP PHYSICIAN
IA25073Medicare ID - Type UnspecifiedGROUP PHYSICIAN PROVIDER