Healthcare Provider Details

I. General information

NPI: 1255545349
Provider Name (Legal Business Name): LAKE MEDICAL BILLING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W OAK TERRACE DR SUITE 107
LEESBURG FL
34748-4457
US

IV. Provider business mailing address

1106 TEAL LN
LADY LAKE FL
32159-5149
US

V. Phone/Fax

Practice location:
  • Phone: 352-326-9638
  • Fax: 352-326-9683
Mailing address:
  • Phone: 352-326-9638
  • Fax: 352-326-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License NumberTT0009233
License Number StateFL

VIII. Authorized Official

Name: WILLIAM S MCPHERSON
Title or Position: OWEN
Credential: RT
Phone: 352-326-9638