Provider Demographics
NPI:1922072776
Name:LAKEWOOD HEALTH CENTER
Entity Type:Organization
Organization Name:LAKEWOOD HEALTH CENTER
Other - Org Name:CHI LAKEWOOD HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAMPOHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-634-2120
Mailing Address - Street 1:600 MAIN AVE S
Mailing Address - Street 2:
Mailing Address - City:BAUDETTE
Mailing Address - State:MN
Mailing Address - Zip Code:56623-2855
Mailing Address - Country:US
Mailing Address - Phone:218-634-2120
Mailing Address - Fax:218-634-1016
Practice Address - Street 1:600 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:BAUDETTE
Practice Address - State:MN
Practice Address - Zip Code:56623-2855
Practice Address - Country:US
Practice Address - Phone:218-634-2120
Practice Address - Fax:218-634-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN331065282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1535HTROtherBLUE CROSS OF MINNESOTA
MN199245700Medicaid