Organization
LAKESIDE HEALTHCARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MI CHAEL W HOUMIEL (VICE PRESIDENT)
(803) 932-7080
Entity
Organization
Contact information
Practice address
203 AMICKS FERRY RD, SUITE 1000, CHAPIN, SC 29036-8663
(803) 932-7080
(803) 932-0879
Mailing address
203 AMICKS FERRY RD, SUITE 1000, CHAPIN, SC 29036-8663
(803) 932-7080
(803) 932-0879
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DE1423
—
SC
Enumeration date
11/21/2005
Last updated
08/22/2020
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