| Lake Regional Clinic - Lake Ozark | |
|
1870 Bagnell Dam Blvd Lake Ozark MO 65049-8658 | |
| (573) 365-2318 | |
| (573) 365-3009 |
| Full Name | Lake Regional Clinic - Lake Ozark |
|---|---|
| Speciality | Clinic/Center |
| Location | 1870 Bagnell Dam Blvd, Lake Ozark, Missouri |
| Authorized Official Name and Position | Kevin Mcroberts (CEO) |
| Authorized Official Contact | 5733488756 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Regional Clinic - Lake Ozark Po Box 801661 Kansas City MO 64180-1661 Ph: (573) 348-8000 | Lake Regional Clinic - Lake Ozark 1870 Bagnell Dam Blvd Lake Ozark MO 65049-8658 Ph: (573) 365-2318 |
| NPI Number | 1700177128 |
|---|---|
| Provider Enumeration Date | 04/20/2011 |
| Last Update Date | 10/13/2023 |
| Medicare PECOS PAC ID | 9133026776 |
|---|---|
| Medicare Enrollment ID | O20140407000623 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700177128 | NPI | - | NPPES |
| 1700177128 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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