NPIMap

Organization Active NPI

Lakeside Medical Center, Inc.

  • Skilled Nursing Facility
  • Pine City, MN
National Provider Identifier
1043200355
Registry record updated Mar 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LAKESIDE MEDICAL CENTER, INC.
Practice address
129 6TH Ave SE
Pine City, MN 55063-1913
Phone
(320) 629-2542
Fax
(320) 629-1093
NPI assigned
Oct 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Richard Allen McMahon
Title
Cfo
Phone
(320) 629-2542

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

129 6TH Ave SE
Pine City, MN 55063-1913

Mailing address

129 6TH Ave SE
Pine City, MN 55063-1913
Phone (320) 629-2542

Other identifiers 3

IdentifierTypeStateIssuer
7111815OtherMNMEDICA
177550200MedicaidMN
0694ELAOtherMNBC/BS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364342400000",
    "number": "1043200355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 6TH AVE SE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631913",
            "telephone_number": "320-629-2542",
            "fax_number": "320-629-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 6TH AVE SE",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550631913",
            "telephone_number": "320-629-2542",
            "fax_number": "320-629-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2013-03-27",
        "status": "A",
        "authorized_official_last_name": "MCMAHON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-629-2542",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "7111815",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177550200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "0694ELA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine City, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.