Provider Demographics
NPI:1205114014
Name:LAKE ERIE MEDICAL & SURGICAL SUPPLY, INC
Entity type:Organization
Organization Name:LAKE ERIE MEDICAL & SURGICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIEREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-847-2710
Mailing Address - Street 1:7560 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9539
Mailing Address - Country:US
Mailing Address - Phone:734-847-3847
Mailing Address - Fax:419-724-1052
Practice Address - Street 1:7560 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-9539
Practice Address - Country:US
Practice Address - Phone:734-847-3847
Practice Address - Fax:419-724-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies