Provider Demographics
NPI:1548456957
Name:LAKE CITY HOME MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:LAKE CITY HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOWDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-752-5833
Mailing Address - Street 1:1468 SW MAIN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1115
Mailing Address - Country:US
Mailing Address - Phone:386-752-5833
Mailing Address - Fax:
Practice Address - Street 1:1468 SW MAIN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1115
Practice Address - Country:US
Practice Address - Phone:386-752-5833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313357332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies