Organization
THE LAKE'S LIVER AND DIGESTIVE HEALTH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN GERARD BYRNE D.O. (PRESIDENT)
(573) 302-7138
Entity
Organization
Contact information
Practice address
1029 NICHOLS RD STE 201, OSAGE BEACH, MO 65065-3008
(573) 302-7138
(573) 302-4686
Mailing address
1029 NICHOLS RD STE 201, OSAGE BEACH, MO 65065-3008
(573) 302-7138
(573) 302-4686
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
DO107693
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16408
ANTHEM BCBS PROVIDER ID
MO
01
—
277180
HEALTHLINK PROIVDER ID
MO
05
—
507523900
—
MO
01
—
DG1541
RR MEDICARE
MO
Enumeration date
04/23/2007
Last updated
10/31/2014
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