Provider Demographics
NPI:1689796054
Name:LAKESIDE SUPPLIES, INC.
Entity Type:Organization
Organization Name:LAKESIDE SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-248-4826
Mailing Address - Street 1:16650 STATE HWY 3
Mailing Address - Street 2:A-81
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:832-248-4826
Mailing Address - Fax:832-224-4865
Practice Address - Street 1:16650 ST. HWY 3
Practice Address - Street 2:A-81
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:832-248-4826
Practice Address - Fax:832-224-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies