LAKE COUNTRY MEDICAL SUPPLIES OF OKMULGEE, LLC
Dialysis Equipment and Supplies
Okmulgee, Oklahoma
Provider NPI: 1376546960
Organization Information: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:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
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 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin