Lakeshore Respiratory Therapy Care Services, Inc

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

9207-45 Issued in WI

Legal business name

LAKESHORE RESPIRATORY THERAPY CARE SERVICES, INC

Practice address

3203 Lincoln Ave Ste 2
Two Rivers, WI 54241-1821

Phone

(820) 683-2068

Fax

(920) 683-9238

NPI assigned

Oct 27, 2006

Organization subpart

No

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

Authorized official

Name

Daniel Haile, REGISTERED NURSE

Title

Officer

Phone

(820) 683-2068

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532563200000",
    "number": "1598841298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3203 LINCOLN AVE STE 2",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542411821",
            "telephone_number": "820-683-2068",
            "fax_number": "920-683-9238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3203 LINCOLN AVE STE 2",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542411821",
            "telephone_number": "820-683-2068",
            "fax_number": "920-683-9238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE RESPIRATORY THERAPY CARE SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2018-07-26",
        "status": "A",
        "authorized_official_last_name": "HAILE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "820-683-2068",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "WI",
            "license": "9207-045",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "WI",
            "license": "9207-45",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE DISTRIBUTOR LICENSE",
            "identifier": "9207-045",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa A Kumbalek, NP
• Lakeshore Apothacare Inc
• Lakeshore Apothacare Inc
• Lakeshore Apothacare Inc.
• Lakeshore Chiropractic, S.C.
• Brian P Laliberte, MD
• N John Laliberte, LPC, CSAC
• Skyler Laliberte
• Hye Chong L Lambert, MD
• Toni L Lampe, LPC

• All providers in Two Rivers, WI
• Oxygen Equipment & Supplies (DME) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.