Organization
LAKESIDE MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD ALLEN MCMAHON (CFO)
(320) 629-2542
Entity
Organization
Contact information
Practice address
129 6TH AVE SE, PINE CITY, MN 55063-1913
(320) 629-2542
(320) 629-1093
Mailing address
129 6TH AVE SE, PINE CITY, MN 55063-1913
(320) 629-2542
(320) 629-1093
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0694ELA
BC/BS
MN
05
—
177550200
—
MN
01
—
7111815
MEDICA
MN
Enumeration date
10/27/2005
Last updated
03/27/2013
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