| Organization Name: | LAKE COUNTRY MEDICAL SUPPLIES, LLC |
| NPI Number: | 1114920816 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RYAN RITTER (PRESIDENT OWNER) |
| Mailing Address: | 702 S Mississippi Ave Atoka |
| State: | OK US |
| Postal Code: | 745253324 |
| Phone Number: | 5808897878 |
| Fax Number: | 5808898713 |
| NPI Enumeration Date: | 05/27/2005 |
| NPI Last Update Date: | 05/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BD1200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Dialysis Equipment & Supplies |
| Taxonomy Definition: | |