Lakewood Health Center
Organization Active NPI Clinic/Center · Baudette, MN
NPI 1972799237 · NPPES record last updated Feb 27, 2020
Key facts
- NPI
- 1972799237
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- LAKEWOOD HEALTH CENTER
- Practice address
- 600 Main Ave S
Baudette, MN 56623-2855 - Phone
- (218) 634-1655
- Fax
- (218) 634-1094
- NPI assigned
- Sep 20, 2007
- Organization subpart
- No
Authorized official
- Name
- Jeffry A Stampohar
- Title
- President
- Phone
- (218) 634-2120
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 4
Practitioners 28
-
Gina Ann Lablanc, CNP
-
Morgan Marie Longtin, FNP-C
-
Matthew Albert McGee, PA-C
-
Justin Quo, M.D.
-
Jerry Russell Bartleson, M.D.
-
Sheila Diane Bullock, FNP-C
-
Fahd Arafat, MD
-
Marianne Renae Foldesi, PA-C
-
Sarah J Gubbels, LICSW
-
Daniel J Margo, M.D.
-
Amy Renee Moser, PMHNP
-
Jordan James Reese, CNP
-
Daniel Scott Vechell, M.D.
-
Courtney Wade Whitney, D.O.
-
David Javier Lopez, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031104000469 | MN | Part B Supplier - Clinic/Group Practice | 5698687929 |
Receives reassigned benefits from 27 practitioners 1 other NPI on this enrollment Practice locations: Baudette, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
600 Main Ave S
Baudette, MN 56623-2855
Mailing address
600 Main Ave S
Baudette, MN 56623-2855
Phone (218) 634-1655
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 199245700 | Medicaid | MN |
Other names
- CHI Lakewood Health
Other providers in Baudette, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.