# LAKESIDE HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780990457
- **Authorized official:** ROSANNE A LEMMER (ADMINISTRATOR)
- **Authorized official phone:** (605) 472-2191

## Contact information

- **Practice address:** 1010 W 5TH ST, REDFIELD, SD 57469-2026
- **Practice address phone:** (605) 472-2191
- **Practice address fax:** (605) 472-2194
- **Mailing address:** 1010 W 5TH ST, REDFIELD, SD 57469-2026
- **Mailing address phone:** (605) 472-2191
- **Mailing address fax:** (605) 472-2194

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 40127 | SD | Yes |

## Other

- **Enumeration date:** 08/19/2010
- **Last updated:** 08/19/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9571840 | — | SD |