NPIMap

Organization Active NPI

Lake Country Urology Clinic, PLLC

Doing business as Lake Country Health Alliance

  • Urology Physician
  • Three Rivers, MI
National Provider Identifier
1952433732
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
LAKE COUNTRY UROLOGY CLINIC, PLLC
Doing business as
Lake Country Health Alliance
Practice address
711 S Health Pkwy
Three Rivers, MI 49093-9387
Phone
(269) 651-4708
NPI assigned
Mar 9, 2007
Last updated
Oct 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Mariano L Orca, M.D.NPI 1932273984
Title
President, PLLC
Phone
(269) 651-4708

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

711 S Health Pkwy
Three Rivers, MI 49093-9387

Mailing address

17 Vinewood Ave
Sturgis, MI 49091-2375
Phone (269) 651-4708

Other names 1

  • LAKE COUNTRY HEALTH ALLIANCE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lake Country Urology CL4 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.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1952433732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 VINEWOOD AVE",
            "city": "STURGIS",
            "state": "MI",
            "postal_code": "490912375",
            "telephone_number": "269-651-4708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 S HEALTH PKWY",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490939387",
            "telephone_number": "269-651-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTRY UROLOGY CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "ORCA",
        "authorized_official_first_name": "MARIANO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT, PLLC",
        "authorized_official_telephone_number": "269-651-4708",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE COUNTRY HEALTH ALLIANCE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Three Rivers, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.