# LAKE MANAGEMENT GROUP

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

## Provider details

- **NPI number:** 1639401771
- **Authorized official:** MRS. ALICIA ESCOBAR DOVER (PRESIDENT)
- **Authorized official phone:** (210) 831-4131

## Contact information

- **Practice address:** 127 AUGUSTA DR, WIMBERLEY, TX 78676-2515
- **Practice address phone:** (210) 831-4131
- **Mailing address:** 127 AUGUSTA DR, WIMBERLEY, TX 78676-2515
- **Mailing address phone:** (210) 831-4131

## Taxonomy

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

## Other

- **Enumeration date:** 01/30/2010
- **Last updated:** 01/30/2010