Provider Demographics
NPI:1184850802
Name:LAKE PULMONARY CRITICAL CARE
Entity Type:Organization
Organization Name:LAKE PULMONARY CRITICAL CARE
Other - Org Name:LAKE SIDESLEEP SUPPLIES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-742-4447
Mailing Address - Street 1:1876 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4359
Mailing Address - Country:US
Mailing Address - Phone:352-742-4447
Mailing Address - Fax:352-742-4448
Practice Address - Street 1:1876 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4359
Practice Address - Country:US
Practice Address - Phone:352-742-4447
Practice Address - Fax:352-742-4448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE PULMONARY CRITICAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-09
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6261850001Medicare NSC