Lake Internal Med Special

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

RIE24 Issued in MO

Legal business name

LAKE INTERNAL MED SPECIAL

Practice address

980 Executive Dr
Suite D
Osage Beach, MO 65065-3495

Phone

(573) 348-6700

Fax

(573) 348-3310

NPI assigned

Jan 16, 2008

Last updated

Jan 16, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. M David East, D.O.

Title

Owner

Phone

(573) 348-6700

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200441600000",
    "number": "1275719627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 EXECUTIVE DR",
            "address_2": "SUITE D",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653495",
            "telephone_number": "573-348-6700",
            "fax_number": "573-348-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 EXECUTIVE DR",
            "address_2": "SUITE D",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653495",
            "telephone_number": "573-348-6700",
            "fax_number": "573-348-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE INTERNAL MED SPECIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-16",
        "last_updated": "2008-01-16",
        "status": "A",
        "authorized_official_last_name": "EAST",
        "authorized_official_first_name": "M",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-348-6700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MO",
            "license": "RIE24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Osage Beach, MO
• Providers in Osage Beach, MO by specialty
• Medical Specialty Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2008; 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.