ANGUS LAKE INFUSION SERVICES NPI 1063855211

NPI Information

NPI: 1063855211
Provider Name: ANGUS LAKE INFUSION SERVICES

Doing Business As: ANGUS LAKE VITAL CARE

Classification: Durable Medical Equipment & Medical Supplies - 332B00000X
Entity Type: Organization
Address:
240 MILLEDGEVILLE RD
SUITE B
GORDON, GA
ZIP 31031
Phone: (478) 387-2399
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ANGUS LAKE INFUSION SERVICES is a durable medical equipment medical supplies in Gordon, GA. The provider is a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time. ANGUS LAKE INFUSION SERVICES NPI is 1063855211. The provider is registered as an organization entity type.
The provider Is Doing Business As Angus Lake Vital Care.

The provider's business location address is:

240 MILLEDGEVILLE RD
SUITE B
GORDON, GA
ZIP 31031-827
Phone: (478) 387-2399
Fax: (478) 628-2263

The provider's authorized official is Carl Lake Stanley .
The authorized official title is Member and has the following contact phone number (478) 387-2399.

The enumeration date for this NPI number is 4/8/2013 and was last updated on 10/18/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	332BP3500X	Durable Medical Equipment & Medical Supplies	Parenteral & Enteral Nutrition	PHHH000055	GEORGIA	No
2	3336C0004X	Pharmacy	Compounding Pharmacy	PHHH000055	GEORGIA	No
3	3336H0001X	Pharmacy	Home Infusion Therapy Pharmacy	PHHH000055	GEORGIA	No
4	332B00000X	Durable Medical Equipment & Medical Supplies		PHHH000055	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	003137168A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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