Provider Demographics
NPI:1538138003
Name:LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
Entity Type:Organization
Organization Name:LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
Other - Org Name:LAKEVIEW HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-430-4581
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-0310
Mailing Address - Country:US
Mailing Address - Phone:651-430-4581
Mailing Address - Fax:651-430-4528
Practice Address - Street 1:927 CHURCHILL ST W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6605
Practice Address - Country:US
Practice Address - Phone:651-430-4529
Practice Address - Fax:651-430-4528
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-16
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330771282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41OtherHEALTHPARTNERS
MN01006069OtherPERFERRED ONE
MN300064OtherUCARE MINNESOTA
WI11005400Medicaid
MN5012806OtherMEDICA CHOICE INSTUTIONAL
MN834547300Medicaid
MN1005491OtherPREFERRED ONE (PEAK)
MN1874HLAOtherMINNESOTA BLUE CROSS
MN8005491OtherPREFERRED COM HEALTH PLAN
WI11005400Medicaid
MN834547300Medicaid