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General NPI Number Information
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NPI Number | 1689796054
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Entity Type | Organization
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Legal Business Name | LAKESIDE SUPPLIES, INC.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16650 ST. HWY 3 A-81
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 832-248-4826
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Fax | 832-224-4865
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Provider Business Mailing Address
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Address Line | 16650 STATE HWY 3 A-81
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 832-248-4826
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Fax | 832-224-4865
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHERRY B. SPELL
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Credential |
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Telephone | 832-248-4826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | NA
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License Number State | TX
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