Organization
LAKESIDE HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSANNE A LEMMER (ADMINISTRATOR)
(605) 472-2191
Entity
Organization
Contact information
Practice address
1010 W 5TH ST, REDFIELD, SD 57469-2026
(605) 472-2191
(605) 472-2194
Mailing address
1010 W 5TH ST, REDFIELD, SD 57469-2026
(605) 472-2191
(605) 472-2194
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
40127
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9571840
—
SD
Enumeration date
08/19/2010
Last updated
08/19/2010
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