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
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