Provider Demographics
NPI:1609245471
Name:LIK DME & MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:LIK DME & MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-418-4316
Mailing Address - Street 1:328 HIGHWAY 12 W
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3604
Mailing Address - Country:US
Mailing Address - Phone:662-418-4316
Mailing Address - Fax:
Practice Address - Street 1:328 HIGHWAY 12 W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3604
Practice Address - Country:US
Practice Address - Phone:662-418-4316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies