Organization
LAKELINE MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYSON JON KRUGMAN DC (OWNER)
(512) 633-5669
Entity
Organization
Contact information
Practice address
1525 CYPRESS CREEK RD STE H, CEDAR PARK, TX 78613-3604
(512) 633-5669
(512) 401-2145
Mailing address
1525 CYPRESS CREEK RD STE H, CEDAR PARK, TX 78613-3604
(512) 633-5669
(512) 401-2145
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0103078
TX
Other
Enumeration date
03/25/2008
Last updated
03/25/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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