Organization
LAKE COUNTRY MEDICAL SUPPLIES OF OKMULGEE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN RITTER D.P.H. (OWNER PRESIDENT)
(580) 889-7800
Entity
Organization
Contact information
Practice address
1180 S BELMONT AVE, OKMULGEE, OK 74447-6308
(918) 756-9279
(918) 756-2656
Mailing address
702 S MISSISSIPPI AVE, ATOKA, OK 74525-3324
(580) 889-7878
(580) 889-8713
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
OK
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
14-S-795
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100812630A
—
OK
Enumeration date
05/27/2005
Last updated
05/26/2011
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