Organization Name:  LAKE COUNTRY MEDICAL SUPPLIES OF OKMULGEE, LLC


Practice Location:
1180 S BELMONT AVE  OKMULGEE, OK 74447 US
Tel: 918-756-9279  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	332BD1200X	Suppliers Durable Medical Equipment & Medical Supplies Dialysis Equipment & Supplies
N	332BN1400X	Suppliers Durable Medical Equipment & Medical Supplies
N	332BP3500X	Suppliers Durable Medical Equipment & Medical Supplies
N	332BX2000X	Suppliers Durable Medical Equipment & Medical Supplies	OK	14-S-795
Y	332B00000X	Suppliers Durable Medical Equipment & Medical Supplies	OK

Other Provider Identifiers:

Issuer	Number	State	Type
	100812630A	OK	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin