Longville Lakes Clinic, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

LONGVILLE LAKES CLINIC, INC.

Practice address

13205 Isle Drive
Baxter, MN 56425

Phone

(218) 546-7000

Fax

(218) 546-4645

NPI assigned

Aug 12, 2013

Organization subpart

No

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

Authorized official

Name

Katie Berg

Title

Cfo

Phone

(218) 546-7000

Specialties & licenses 1

Addresses

Other names 1

• Cuyuna Regional Medical Center Doing business as

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

CLIA laboratory certificates

Tax ID family

Longville Lakes Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Cuyuna Regional Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Crosby, MN
  • NPI 1033289707
  NPD tax ID
• Cuyuna Regional Medical Center

  • Non-Pharmacy Dispensing Site
  • Nisswa, MN
  • NPI 1154236883
  NPD tax ID
• Cuyuna Regional Medical Center

  • Rural Health Clinic/Center
  • Crosby, MN
  • NPI 1447108253
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward Lee Rosenbaum, MD

  • Family Medicine Physician
  • Crosby, MN
  • NPI 1174507925
  NPD (past)

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1801229000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 E MAIN ST",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411645",
            "telephone_number": "218-546-7000",
            "fax_number": "218-546-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13205 ISLE DRIVE",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "56425",
            "telephone_number": "218-546-7000",
            "fax_number": "218-546-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGVILLE LAKES CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-12",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-546-7000"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cuyuna Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cuyuna Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Megan Marie Litzau
• Nicholas M Loken, DO
• Staci K Loken, DO
• Taylor James Long
• Crystal J Longseth
• Alicia Fiona Lund
• Joshua Lundquist
• Hannah Lundstrom
• Paul Lundstrom, MD
• Caleb Michael Lunning, DDS

• Clinic/Center in Baxter, MN
• Providers in Baxter, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.