Provider Demographics
NPI:1891979837
Name:LANETT MEDICAL SUPPLIES & SERVICES, INC
Entity Type:Organization
Organization Name:LANETT MEDICAL SUPPLIES & SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BENS VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-642-1524
Mailing Address - Street 1:119 VALLEY PLAZA SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:LANETT
Mailing Address - State:AL
Mailing Address - Zip Code:36863
Mailing Address - Country:US
Mailing Address - Phone:334-642-1524
Mailing Address - Fax:334-642-1526
Practice Address - Street 1:119 VALLEY PLAZA SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:LANETT
Practice Address - State:AL
Practice Address - Zip Code:36863-2075
Practice Address - Country:US
Practice Address - Phone:334-642-1524
Practice Address - Fax:334-642-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTAX ID