Provider Demographics
NPI:1659326270
Name:LAKELAND MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:LAKELAND MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-983-8399
Mailing Address - Street 1:211 HILLTOP RD
Mailing Address - Street 2:SUITE S
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2300
Mailing Address - Country:US
Mailing Address - Phone:269-983-0202
Mailing Address - Fax:269-982-0224
Practice Address - Street 1:211 HILLTOP RD
Practice Address - Street 2:SUITE S
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2300
Practice Address - Country:US
Practice Address - Phone:269-983-0202
Practice Address - Fax:269-982-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4767427Medicaid
MI4767427Medicaid