# LAKELINE MEDICAL SUPPLY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043482540
- **Authorized official:** TYSON JON KRUGMAN DC (OWNER)
- **Authorized official phone:** (512) 633-5669

## Contact information

- **Practice address:** 1525 CYPRESS CREEK RD STE H, CEDAR PARK, TX 78613-3604
- **Practice address phone:** (512) 633-5669
- **Practice address fax:** (512) 401-2145
- **Mailing address:** 1525 CYPRESS CREEK RD STE H, CEDAR PARK, TX 78613-3604
- **Mailing address phone:** (512) 633-5669
- **Mailing address fax:** (512) 401-2145

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 0103078 | TX | Yes |

## Other

- **Enumeration date:** 03/25/2008
- **Last updated:** 03/25/2008