Provider Demographics
NPI:1659361889
Name:LAKELAND MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:LAKELAND MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPED
Authorized Official - Phone:574-268-1694
Mailing Address - Street 1:PO BOX 1804
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46581-1804
Mailing Address - Country:US
Mailing Address - Phone:574-268-1694
Mailing Address - Fax:574-268-1699
Practice Address - Street 1:827 S UNION ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4703
Practice Address - Country:US
Practice Address - Phone:574-268-1694
Practice Address - Fax:574-268-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4365250001Medicare ID - Type Unspecified