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Organization
MOUNTAIN LAKES MEDICAL SUPPLY INC
Active
Organization
MOUNTAIN LAKES MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC K LAPHAM RCP (OWNER OPERATOR)
(909) 585-1339
Entity
Organization
Contact information
Practice address
226 E. FAIRWAY BLVD, BIG BEAR CITY, CA 92314-9050
(909) 585-1339
(909) 585-3646
Mailing address
PO BOX 1679, BIG BEAR CITY, CA 92314-9050
(909) 585-1339
(909) 585-3646
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
102727
CA
Other
Enumeration date
10/18/2006
Last updated
07/18/2008
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