Lake Diabetes Supply, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

LAKE DIABETES SUPPLY, INC

Practice address

2150 Collier Ave
Suite R
Fort Myers, FL 33901-8129

Phone

(239) 275-8080

Fax

(239) 274-8161

NPI assigned

Sep 13, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Richard B. Hartwell

Title

President

Phone

(386) 304-5941

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Lake Diabetes Supply Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Lake Diabetes Supply, Inc

  • Health Educator
  • Melbourne, FL
  • NPI 1568763696
  NPD tax ID
• Lake Diabetes Supply, Inc

  • Durable Medical Equipment & Medical Supplies
  • Daytona Beach Shores, FL
  • NPI 1861487191
  NPD tax ID

Locations

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1326033648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 N HARBOR CITY BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329356838",
            "telephone_number": "321-255-9800",
            "fax_number": "321-751-1145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 COLLIER AVE",
            "address_2": "SUITE R",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339018129",
            "telephone_number": "239-275-8080",
            "fax_number": "239-274-8161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE DIABETES SUPPLY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HARTWELL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-304-5941",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IDENTIFIER",
            "identifier": "R9285",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie A Lage, PA-C
• Emely Lago
• Alex Leyon Lagodzinski, APRN, FNP-BC
• Robert George Anthony Laing
• Kelli Laird, LPN
• Lake Family Counseling, LLC
• James Andrew Lake, LCMFT, SCC-C, DMINN
• Lakshmi Bushan MD PA
• Emily Laliberte
• Bharti S Lalla, M.D.

• Durable Medical Equipment & Medical Supplies in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.