Provider Demographics
NPI:1356827638
Name:LAKEVIEW MEDICAL CENTER INC OF RICE LAKE
Entity Type:Organization
Organization Name:LAKEVIEW MEDICAL CENTER INC OF RICE LAKE
Other - Org Name:MARSHFIELD MEDICAL CENTER - RICE LAKE DMEPOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, AO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-387-9370
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT SVCS - SHP FL2
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 W STOUT ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-5000
Practice Address - Country:US
Practice Address - Phone:715-236-6133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHFIELD CLINIC HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-19
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies