Provider Demographics
NPI:1952363608
Name:IOWA LAKES ORTHOPAEDICS , P.C.
Entity Type:Organization
Organization Name:IOWA LAKES ORTHOPAEDICS , P.C.
Other - Org Name:IOWA LAKES ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-336-5311
Mailing Address - Street 1:2309 23RD ST.
Mailing Address - Street 2:P. O. BOX 273
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-0273
Mailing Address - Country:US
Mailing Address - Phone:712-336-5311
Mailing Address - Fax:712-336-0020
Practice Address - Street 1:2309 23RD ST.
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-0273
Practice Address - Country:US
Practice Address - Phone:712-336-5311
Practice Address - Fax:712-336-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0070292Medicaid
MN2401560Medicaid
MNC08410Medicare ID - Type UnspecifiedWINDOM CLINIC
MN2401560Medicaid
IA0288350006Medicare NSC
MN0288350004Medicare NSC
MN0288350002Medicare NSC
IA0288350001Medicare NSC
MN0288350006Medicare NSC
MNC08409Medicare ID - Type UnspecifiedWORTHINGTON CLINIC
IA02698Medicare ID - Type Unspecified
IA0070292Medicaid
MN01410Medicare ID - Type UnspecifiedRAILROAD MEDICARE
IA0288350004Medicare NSC
MN0288350001Medicare NSC