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Organization
LAKE COUNTRY MEDICAL SUPPLIES, LLC
Active
Organization
LAKE COUNTRY MEDICAL SUPPLIES, LLC
Active
Other names
Complete Care Medical
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR CLAY (OWNER)
(580) 286-5022
Entity
Organization
Contact information
Practice address
744 S MISSISSIPPI AVE, ATOKA, OK 74525-3355
(580) 889-7878
Mailing address
744 S MISSISSIPPI AVE, ATOKA, OK 74525-3355
(580) 889-7878
(580) 889-8713
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
OK
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
57-S-940
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100813530A
—
OK
01
—
742803495001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
05/27/2005
Last updated
06/25/2019
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