Lakewalk Surgery Center, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

331053 Issued in MN

Legal business name

LAKEWALK SURGERY CENTER, INC.

Practice address

1420 London Rd
Suite 100
Duluth, MN 55805-2433

Phone

(218) 728-0650

Fax

(218) 728-8557

NPI assigned

Jun 17, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Joe R Majerus

Title

Administrator

Phone

(218) 728-8505

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Listed as

Lakewalk Surgery CenterCCN 24C0001026

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Lakewalk Surgery Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Lakewalk Surgery Center, Inc.

  • Ambulatory Surgical Clinic/Center
  • Duluth, MN
  • NPI 1023651916
  NPD tax ID

Practitioners 1

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

• Robin Wayne Hendricks, M.D.

  • Specialist
  • Duluth, MN
  • NPI 1245235746
  NPD (past)

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891730644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 LONDON RD",
            "address_2": "SUITE 100",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052433",
            "telephone_number": "218-728-0650",
            "fax_number": "218-728-8557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 LONDON RD",
            "address_2": "SUITE 100",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052433",
            "telephone_number": "218-728-0650",
            "fax_number": "218-728-8557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWALK SURGERY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAJERUS",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "218-728-8505",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MN",
            "license": "331053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Vision PLLC
• Ronald Lake, MSW LICSW
• Lakeside Dental Associates, PA
• Lakewalk Imaging, LLC
• Lakewalk Surgery Center, Inc.
• Lakewind, Inc
• Kimberly Jean Lakhan
• Frederick Reynold Lakso, PA
• Holly Laluzerne, MS ED.
• Lynne Elizabeth Lamar

• Ambulatory Surgical Clinic/Center in Duluth, MN
• Providers in Duluth, MN by specialty
• Ambulatory Surgical Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.