NPIMap

Organization Active NPI

Mike Stuart Enterprises, Inc.

Doing business as Lakeland Pharmacy #7

  • Community/Retail Pharmacy
  • Willow Springs, MO
National Provider Identifier
1144560319
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2013004561 Issued in MO
Legal business name
MIKE STUART ENTERPRISES, INC.
Doing business as
Lakeland Pharmacy #7
Practice address
110 Bear Dr Ste 4
Willow Springs, MO 65793-7103
Phone
(417) 469-9009
Fax
(417) 469-5005
NPI assigned
Feb 25, 2013
Last updated
Jun 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Authorized official

Name
Michael Stuart
Title
Owner/President
Phone
(417) 272-8064

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 2013004561 MO
Community/Retail Pharmacy 3336C0003X 2013004561 MO Primary

Addresses

Primary practice location

110 Bear Dr Ste 4
Willow Springs, MO 65793-7103

Mailing address

18565 Business 13
Branson West, MO 65737-9659
Phone (417) 272-8064

Other identifiers 2

IdentifierTypeStateIssuer
2640921OtherNCPDP PROVIDER IDENTIFICATION NUMBER
600005149MedicaidMO

Other names 1

  • LAKELAND PHARMACY #7 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091002000512 MO Part B Supplier - Mass Immunization (Roster Biller Only) 5193861201 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Branson, MO; Branson West, MO; Crane, MO; Forsyth, MO; Willow Springs, MO

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

110 Bear Dr
Ste 4
Willow Springs, MO 65793
Phone (417) 469-9009

857 E Main St
Ste 3
Willow Springs, MO 65793
Phone (417) 855-0428

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1361750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1144560319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18565 BUSINESS 13",
            "city": "BRANSON WEST",
            "state": "MO",
            "postal_code": "657379659",
            "telephone_number": "417-272-8064",
            "fax_number": "417-272-0073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BEAR DR STE 4",
            "city": "WILLOW SPRINGS",
            "state": "MO",
            "postal_code": "657937103",
            "telephone_number": "417-469-9009",
            "fax_number": "417-469-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKE STUART ENTERPRISES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-25",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A",
        "authorized_official_last_name": "STUART",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "417-272-8064"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "2013004561",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2013004561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2640921",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600005149",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKELAND PHARMACY #7",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willow Springs, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.