Provider Demographics
NPI:1922106202
Name:LAKES REGIONAL HEALTHCARE
Entity Type:Organization
Organization Name:LAKES REGIONAL HEALTHCARE
Other - Org Name:AVERA MEDICAL GROUP LAKES FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position: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:712-336-1230
Mailing Address - Street 1:2700 23RD ST
Mailing Address - Street 2:STE C
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1158
Mailing Address - Country:US
Mailing Address - Phone:712-336-3750
Mailing Address - Fax:712-336-3730
Practice Address - Street 1:2700 23RD ST
Practice Address - Street 2:STE C
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360
Practice Address - Country:US
Practice Address - Phone:712-336-3750
Practice Address - Fax:712-336-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0144840Medicaid
54897Medicare PIN