# MOUNTAIN LAKES MEDICAL SUPPLY INC

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

## Provider details

- **NPI number:** 1639250046
- **Authorized official:** MARC K LAPHAM RCP (OWNER OPERATOR)
- **Authorized official phone:** (909) 585-1339

## Contact information

- **Practice address:** 226 E. FAIRWAY BLVD, BIG BEAR CITY, CA 92314-9050
- **Practice address phone:** (909) 585-1339
- **Practice address fax:** (909) 585-3646
- **Mailing address:** PO BOX 1679, BIG BEAR CITY, CA 92314-9050
- **Mailing address phone:** (909) 585-1339
- **Mailing address fax:** (909) 585-3646

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 102727 | CA | Yes |

## Other

- **Enumeration date:** 10/18/2006
- **Last updated:** 07/18/2008