Organization
LAKE SUPERIOR MEDICAL EQUIPMENT, INC
Active
Parent organization
LAKE SUPERIOR MEDICAL EQUIPMENT, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE SUPERIOR MEDICAL EQUIPMENT, INC
Authorized official
MRS. KATHY WATTERS (GENERAL MANAGER)
(218) 727-0600
Entity
Organization
Contact information
Practice address
901 STANLEY AVE, CLOQUET, MN 55720-3186
(218) 879-2211
(218) 879-2233
Mailing address
901 STANLEY AVE, CLOQUET, MN 55720-3186
(218) 879-2211
(218) 879-2233
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
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
04/22/2013
Last updated
10/04/2016
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