Organization
LAKE SUPERIOR MEDICAL EQUIPMENT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY WATTERS (GENERAL MGR)
(218) 727-0600
Entity
Organization
Contact information
Practice address
522 E 4TH ST, DULUTH, MN 55805-1936
(218) 727-0600
(218) 727-2209
Mailing address
522 E 4TH ST, DULUTH, MN 55805-1936
(218) 727-0600
(218) 727-2209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
5762874
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125158900
—
MN
01
—
169334
UCARE
MN
01
—
275S9LA
BLUE CROSS BLUE SHIELD
MN
05
—
41725700
—
WI
01
—
8200355
MEDICA/SELECT CARE
MN
Enumeration date
06/13/2005
Last updated
07/07/2016
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