Provider Demographics
NPI:1730213653
Name:LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
Entity type:Organization
Organization Name:LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-430-4581
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-0310
Mailing Address - Country:US
Mailing Address - Phone:651-430-4529
Mailing Address - Fax:651-430-4528
Practice Address - Street 1:927 CHURCHILL ST W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6605
Practice Address - Country:US
Practice Address - Phone:651-430-4529
Practice Address - Fax:651-430-4528
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1005491OtherPEAK ADM SERV AMBULANCE
MN1006069OtherPREFERRED ONE
MN8005491OtherPREFER ONE COMM AMBULANCE
MN834547300Medicaid
WI41349600Medicaid
MN5R12LAOtherBLUE CROSS MN AMBULANCE
MN41OtherHEALTHPARTNERS AMBULANCE
MN5012806OtherMEDICA CHOICE AMBULANCE
MN1006069OtherPREFERRED ONE
MN240066Medicare Oscar/Certification