Provider Demographics
NPI:1922587427
Name:LINCOLN LAKES MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:LINCOLN LAKES MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:GULESIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:207-403-9411
Mailing Address - Street 1:150 WEST BROADWAY SUITE 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457
Mailing Address - Country:US
Mailing Address - Phone:207-794-5356
Mailing Address - Fax:
Practice Address - Street 1:150 W BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4003
Practice Address - Country:US
Practice Address - Phone:207-403-9411
Practice Address - Fax:207-403-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies