Lakeview Memorial Hospital Assn, Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

200202-2 Issued in MN

Legal business name

LAKEVIEW MEMORIAL HOSPITAL ASSN, INC

Practice address

927 Churchill St W
Stillwater, MN 55082-6605

Phone

(651) 430-4562

Fax

(651) 430-8540

NPI assigned

Oct 31, 2006

Organization subpart

No

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

Authorized official

Name

Douglas Edward Johnson

Title

Cfo

Phone

(651) 430-4581

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Lakeview Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Lakeview Memorial Hospital Association Inc

  • Pharmacy
  • Stillwater, MN
  • NPI 1326124454

  O20100930065724

  Same enrollment

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Lakeview Memorial Hospital Assn, Inc.

  • Non-Pharmacy Dispensing Site
  • Stillwater, MN
  • NPI 1598075012
  NPPES parent name

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1295811313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 CHURCHILL ST W",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826605",
            "telephone_number": "651-439-5330",
            "fax_number": "651-430-8540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 CHURCHILL ST W",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826605",
            "telephone_number": "651-430-4562",
            "fax_number": "651-430-8540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVIEW MEMORIAL HOSPITAL ASSN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-430-4581"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MN",
            "license": "200202-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33218600",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194023600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "241225-7",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeview Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lakeview Memorial Hospital Assn, Inc.
• Lakeview Memorial Hospital Association Inc
• Lakeview Memorial Hospital Association Inc
• Lakeview Memorial Hospital Association Inc
• Lakeview Memorial Hospital Association Inc.

• All providers in Stillwater, MN
• Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; 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.