Organization
LAKESIDE MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD 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
282N00000X
General Acute Care Hospital
Primary
330908
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0694HLA
BLUECROSS BLUESHEILD
MN
01
—
5017321
MEDICA
MN
Enumeration date
04/12/2006
Last updated
08/22/2020
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