Provider Demographics
NPI:1306017223
Name:LANES-DME, INC.
Entity Type:Organization
Organization Name:LANES-DME, INC.
Other - Org Name:LANES MEDICAL SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:WOMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-758-9111
Mailing Address - Street 1:210 W MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3434
Mailing Address - Country:US
Mailing Address - Phone:229-758-9111
Mailing Address - Fax:229-758-9000
Practice Address - Street 1:210 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3434
Practice Address - Country:US
Practice Address - Phone:229-758-9111
Practice Address - Fax:229-758-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA801046279AMedicaid
GA801046279BMedicaid
GA1253310001Medicare NSC