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General NPI Number Information
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NPI Number | 1922587427
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Entity Type | Organization
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Legal Business Name | LINCOLN LAKES MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 150 W BROADWAY STE 2
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City | LINCOLN
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State | ME
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Zip | 04457-4003
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Country | US
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Telephone | 207-403-9411
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Fax | 207-403-9415
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Provider Business Mailing Address
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Address Line | 150 WEST BROADWAY SUITE 2
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City | LINCOLN
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State | ME
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Zip | 04457
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Country | US
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Telephone | 207-794-5356
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. CHRISTOPHER HERBERT GULESIAN
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Credential | RRT
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Telephone | 207-403-9411
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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 |
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License Number State |
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