Provider Demographics
NPI:1588120513
Name:LAKEVIEW MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:LAKEVIEW MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-727-0277
Mailing Address - Street 1:201 S 2ND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4328
Mailing Address - Country:US
Mailing Address - Phone:888-327-0170
Mailing Address - Fax:
Practice Address - Street 1:201 S 2ND ST STE 210
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4328
Practice Address - Country:US
Practice Address - Phone:888-327-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies