Provider Demographics
NPI:1689762106
Name:LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE
Entity Type:Organization
Organization Name:LAKEVIEW MEDICAL CENTER, INC. OF RICE LAKE
Other - Org Name:LAKEVIEW MEDICAL CENTER HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE, CFO FINANCE, 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 1:1700 W STOUT ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-5000
Mailing Address - Country:US
Mailing Address - Phone:715-236-6256
Mailing Address - Fax:
Practice Address - Street 1:2304 S MAIN ST, STE 6
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2900
Practice Address - Country:US
Practice Address - Phone:715-236-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHFIELD CLINIC HEALTH SYSTEM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI555251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43187300Medicaid
WI43187300Medicaid