Provider Demographics
NPI:1013504075
Name:LAKEVIEW MEDICAL CENTER INC OF RICE LAKE
Entity type:Organization
Organization Name:LAKEVIEW MEDICAL CENTER INC OF RICE LAKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 SHP FL2
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-389-0660
Mailing Address - Fax:
Practice Address - Street 1:806 2ND ST
Practice Address - Street 2:
Practice Address - City:CHETEK
Practice Address - State:WI
Practice Address - Zip Code:54728-2800
Practice Address - Country:US
Practice Address - Phone:715-924-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHFIELD CLINIC HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-24
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health