NPIMap

Organization Active NPI

Lakeview Memorial Hospital Association Inc

Doing business as Lakeview Outpatient Pharmacy

  • Pharmacy
  • Stillwater, MN
National Provider Identifier
1326124454
Registry record updated Feb 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
2612331 Issued in MN
Legal business name
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
Doing business as
Lakeview Outpatient Pharmacy
Practice address
927 Churchill St W
Stillwater, MN 55082-6605
Phone
(651) 430-4563
Fax
(651) 430-4630
NPI assigned
Oct 31, 2006
Last updated
Feb 3, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2017

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 261233 MN
Pharmacy 333600000X 2612331 MN Primary

Addresses

Primary practice location

927 Churchill St W
Stillwater, MN 55082-6605

Mailing address

927 Churchill St W
Stillwater, MN 55082-6605
Phone (651) 430-4563

Other identifiers 3

IdentifierTypeStateIssuer
194023600MedicaidMN
242458-1OtherMNNABP NUMBER
33218600MedicaidWI

Other names 1

  • Lakeview Outpatient Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930065724 MN DME Supplier - Pharmacy 1951210855 2 other NPIs on this enrollment
Practice locations: Stillwater, MN

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Lakeview Mem Hosp8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

14702 60th St N
Oak Park Heights, MN 55082
Phone (651) 439-5330

1715 Tower Dr W
Ste 330
Stillwater, MN 55082
Phone (651) 430-3320

850 Churchill St W
Stillwater, MN 55082
Phone (651) 439-5330

Practitioners & affiliated clinicians

Practitioners 140

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.

View all 140

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486080000000",
    "number": "1326124454",
    "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": "651-430-4563",
            "fax_number": "651-430-4630"
        },
        {
            "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": "651-430-4563",
            "fax_number": "651-430-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2017-02-03",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": "261233",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MN",
            "license": "2612331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "194023600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "242458-1",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33218600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeview Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stillwater, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; 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.