Provider Demographics
NPI:1083743694
Name:LAZBOY
Entity Type:Organization
Organization Name:LAZBOY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JARBOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-375-6727
Mailing Address - Street 1:3606 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2552
Mailing Address - Country:US
Mailing Address - Phone:352-375-6727
Mailing Address - Fax:352-375-6998
Practice Address - Street 1:3606 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2552
Practice Address - Country:US
Practice Address - Phone:352-375-6727
Practice Address - Fax:352-375-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11-8013402238-3332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies