Provider Demographics
NPI:1417217621
Name:LG MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:LG MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:O
Authorized Official - Last Name:AGYEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-670-3925
Mailing Address - Street 1:6205 TARBERRY PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4195
Mailing Address - Country:US
Mailing Address - Phone:571-490-2187
Mailing Address - Fax:
Practice Address - Street 1:3108 PS BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4258
Practice Address - Country:US
Practice Address - Phone:703-670-3925
Practice Address - Fax:703-670-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies