Lake Country Medical Supplies, LLC

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

57-S-940 Issued in OK

Legal business name

LAKE COUNTRY MEDICAL SUPPLIES, LLC

Practice address

744 S Mississippi Ave
Atoka, OK 74525-3355

Phone

(580) 889-7878

NPI assigned

May 27, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Victor Clay

Title

Owner

Phone

(580) 286-5022

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• Complete Care Medical Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561420800000",
    "number": "1114920816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 S MISSISSIPPI AVE",
            "city": "ATOKA",
            "state": "OK",
            "postal_code": "745253355",
            "telephone_number": "580-889-7878",
            "fax_number": "580-889-8713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 S MISSISSIPPI AVE",
            "city": "ATOKA",
            "state": "OK",
            "postal_code": "745253355",
            "telephone_number": "580-889-7878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "702 S Mississippi Ave",
            "address_purpose": "LOCATION",
            "city": "Atoka",
            "state": "OK",
            "postal_code": "745253324",
            "country_code": "US",
            "telephone_number": "580-889-7878",
            "fax_number": "580-889-8713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE COUNTRY MEDICAL SUPPLIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-27",
        "last_updated": "2019-06-25",
        "status": "A",
        "authorized_official_last_name": "CLAY",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-286-5022"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OK",
            "license": null,
            "primary": false
        },
        {
            "code": "332BD1200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Dialysis Equipment & Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "OK",
            "license": "57-S-940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100813530A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "742803495001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Complete Care Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Ann Kingsley
• Cheryl Denise Kite
• James H Klingler
• Teena L Knight
• Lake Country Medical Billing LLC
• Michelle Lampkin
• Secret Nicole Lang
• Lanig Health RX-N-RN LLC
• David Jason Lanig, PHARM D
• Ethan Hight Linscott, DO

• Oxygen Equipment & Supplies (DME) in Atoka, OK
• Providers in Atoka, OK by specialty
• Oxygen Equipment & Supplies (DME) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.