Lake of the Ozarks Pain Management Services, Inc
Organization Active NPI Specialist · Osage Beach, MO
NPI 1003901976 · NPPES record last updated May 25, 2012
Key facts
- NPI
- 1003901976
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- LAKE OF THE OZARKS PAIN MANAGEMENT SERVICES, INC
- Practice address
- 54 Hospital Dr
Osage Beach, MO 65065-3050 - Phone
- (573) 302-1661
- NPI assigned
- Oct 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Alan W Mead, MD
- Title
- Owner
- Phone
- (573) 302-1661
Practitioners 42
-
Mary Kay Bader, CRNA
-
Alysa Barcus, CRNA
-
Adam M Boone, CRNA
-
Steven B Bouck, CRNA
-
Chandler Bowser, CRNA
-
Darla Lasters Brown, CRNA
-
Jamianne Cairns, DNAP, CRNA
-
Julie M Ferguson, CRNA
-
Paul Joseph Imperato, CRNA
-
Stephanie Ann Jenkins, CRNA
-
Sara L Kruse, CRNA
-
Kenneth R. Leimkuehler, CRNA
-
Kevin J Lockett, CRNA
-
Nicholas Lyons, CRNA
-
Glenn W McLendon, CRNA
-
Taibatu Mohammed Awal, CRNA
-
Judith Anne Moran, C.R.N.A.
-
Kristina Marie Reed, CRNA
-
Rob Roy Reed, CRNA
-
Tony Lee Roberts Jr., CRNA
-
Amy Dianne Shatto, CRNA
-
Cheri Stadnyk, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041013000118 | MO | Part B Supplier - Clinic/Group Practice | 0547220774 |
Receives reassigned benefits from 1 practitioner Practice locations: Osage Beach, MO |
National Provider Directory
Locations
5151 Osage Beach Pkwy
Ste F
Osage Beach, MO 65065
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
54 Hospital Dr
Osage Beach, MO 65065-3050
Mailing address
5151 Osage Beach Pkwy Ste F
PO Box 840
Osage Beach, MO 65065-3285
Phone (573) 302-1661
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 508901402 | Medicaid | MO |
Other providers in Osage Beach, MO
- Lake Behavioral Health
- Lake Behavioral Health Associates, LLC
- Lake Cardiovascular Institute, PC
- Lake Family Dentistry
- Lake Internal Med Special
- Lake Orthopedic Group, Inc.
- Lake Ozark Anesthesia & Associates, Inc
- Lake Ozark Retirement Center, Inc.
- Lake Regional Health System
- Lake Regional Health System
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.