Provider Demographics
NPI:1356438519
Name:LAN MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:LAN MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-367-6888
Mailing Address - Street 1:13867 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3008
Mailing Address - Country:US
Mailing Address - Phone:818-367-6888
Mailing Address - Fax:818-367-6807
Practice Address - Street 1:13867 FOOTHILL BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3008
Practice Address - Country:US
Practice Address - Phone:818-367-6888
Practice Address - Fax:818-367-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103463332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4968550001Medicare NSC