The Lake'S Liver and Digestive Health Center Inc

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

DO107693 Issued in MO

Legal business name

THE LAKE'S LIVER AND DIGESTIVE HEALTH CENTER INC

Practice address

1029 Nichols Rd Ste 201
Osage Beach, MO 65065-3008

Phone

(573) 302-7138

Fax

(573) 302-4686

NPI assigned

Apr 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kevin Gerard Byrne, D.O.

Title

President

Phone

(573) 302-7138

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414713600000",
    "number": "1124246160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 NICHOLS RD STE 201",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653008",
            "telephone_number": "573-302-7138",
            "fax_number": "573-302-4686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 NICHOLS RD STE 201",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653008",
            "telephone_number": "573-302-7138",
            "fax_number": "573-302-4686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAKE'S LIVER AND DIGESTIVE HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2014-10-31",
        "status": "A",
        "authorized_official_last_name": "BYRNE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "GERARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-302-7138",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "DO107693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507523900",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DG1541",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PROVIDER ID",
            "identifier": "16408",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK PROIVDER ID",
            "identifier": "277180",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Supitilov
• Surgical Institute of Lake of the Ozarks LLC
• Susan Elaine Mitchell
• Lauren Elizabeth Taylor, OTR/L
• Jordan Alaine Teeple, MS, RD, LD
• Kristen Anne Theobald-Hazel, DO
• Amy B Thompson, M.D.
• Amy Tillotson, RD, LD
• Stephanie L Tittle, AUD
• Keri Ann Toebben

• Gastroenterology Physician in Osage Beach, MO
• Providers in Osage Beach, MO by specialty
• Gastroenterology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2014; 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.