MEDICARE: LAKELAND MEDICAL SUPPLY 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

General Provider Information

NPI Number	:	1659361889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKELAND MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	PO BOX 1804
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46581-1804
Country	:	US
Telephone Number	:	574-268-1694
Fax Number	:	574-268-1699

Provider Business Practice Location Address
First Line	:	827 S UNION ST
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-4703
Country	:	US
Telephone Number	:	574-268-1694
Fax Number	:	574-268-1699

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HOWARD E WOODWARD JR.
Credential	:	C.PED
Telephone Number	:	574-268-1694

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	08/22/2020

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