MEDICARE: LAKE CITY HOME MEDICAL EQUIPMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1313357	FL

General Provider Information

NPI Number	:	1548456957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE CITY HOME MEDICAL EQUIPMENT, INC.

Provider Business Mailing Address
First Line	:	1468 SW MAIN BLVD
Second Line	:	SUITE 100
City	:	LAKE CITY
State	:	FL
Zip	:	32025-1115
Country	:	US
Telephone Number	:	386-752-5833
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 SW MAIN BLVD
Second Line	:	SUITE 100
City	:	LAKE CITY
State	:	FL
Zip	:	32025-1115
Country	:	US
Telephone Number	:	386-752-5833
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. JOHN MICHAEL BOWDOIN
Credential	:
Telephone Number	:	386-752-5833

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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