Lake Regional Health System
Organization Active NPI Community/Retail Pharmacy · Eldon, MO
NPI 1780116657 · NPPES record last updated Jan 7, 2025
Key facts
- NPI
- 1780116657
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2017025596 (MO)
- Legal business name
- LAKE REGIONAL HEALTH SYSTEM
- Practice address
- 416B S Maple St
Eldon, MO 65026-1812 - Phone
- (573) 557-2231
- Fax
- (573) 392-5808
- NPI assigned
- Mar 30, 2017
- Organization subpart
- No
Authorized official
- Name
- Paula Sue Littleton
- Title
- Cfo
- Phone
- (573) 348-8388
Corporate family (same tax ID) 19
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0445864 | Lake Regional Health System - Eldon | Certificate of waiver | Apr 23, 2027 |
National Provider Directory
- Tax ID family
- Lake of the Ozarks Gene
Locations
416 S Maple St
#B
Eldon, MO 65026
Phone (573) 557-2231
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 2017025596 | MO | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
416B S Maple St
Eldon, MO 65026-1812
Mailing address
PO Box 1560
Osage Beach, MO 65065-1560
Phone (573) 302-3185
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 600045506 | Medicaid | MO | |
| 2168691 | Other | PK |
Other names
- Lake Regional Pharmacy - Eldon
Other providers in Eldon, MO
- Jerry D King
- Kristi King
- Lauren Danielle Koelling
- Katlyn Renee Kruse
- Lake Regional Health System
- Leasing Systems, Inc.
- Lee House Senior Living, LLC
- Diane Lynne Lewis
- Michael James Lewis
- Taylor Elizabeth Liska
All providers in Eldon, MO · Community/Retail Pharmacy in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.