| Organization Name: | LAKE SUPERIOR MEDICAL EQUIPMENT INC |
| NPI Number: | 1205129756 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURIE ANN KING (PRESIDENT) |
| Mailing Address: | 211 W Hwy 61 Grand Marais |
| State: | MN US |
| Postal Code: | 556041500 |
| Phone Number: | 2183871584 |
| Fax Number: | 2183871574 |
| NPI Enumeration Date: | 05/17/2011 |
| NPI Last Update Date: | 05/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | 361203 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |