Provider Demographics
NPI:1255545349
Name:LAKE MEDICAL BILLING SERVICES INC
Entity type:Organization
Organization Name:LAKE MEDICAL BILLING SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWEN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:352-326-9638
Mailing Address - Street 1:1106 TEAL LN
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-5149
Mailing Address - Country:US
Mailing Address - Phone:352-326-9638
Mailing Address - Fax:352-326-9683
Practice Address - Street 1:340 W OAK TERRACE DR
Practice Address - Street 2:SUITE 107
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4457
Practice Address - Country:US
Practice Address - Phone:352-326-9638
Practice Address - Fax:352-326-9683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT0009233293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID #