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ANGUS LAKE VITAL CARE
NPI 1063855211
Durable Medical Equipment & Medical Supplies in Gordon, GA

Active since April 08, 2013
240 MILLEDGEVILLE RD, SUITE B, GORDON, GA 31031(478) 387-2399(478) 628-2263 Get Directions Write a Review

NPPES record last updated: October 18, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Angus Lake Vital Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANGUS LAKE VITAL CARE (NPI 1063855211) is a healthcare organization registered as a durable medical equipment & medical supplies in Gordon, Georgia and active in the NPI registry since April 2013. The organization lists Carl Lake Stanley, Member, as its authorized official.

NPPES Registry Identity

NPI1063855211
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameANGUS LAKE INFUSION SERVICES
Location Address240 MILLEDGEVILLE RD, SUITE BGordon, GA 31031-3827
Mailing AddressPo Box 249Gordon, GA 31031-0249 · (478) 387-2399 · Fax (478) 628-2263
Phone(478) 387-2399
Fax(478) 628-2263
Organization SubpartNo
Authorized OfficialCarl Lake StanleyMember · (478) 387-2399
Enumeration DateApril 8, 2013
Last NPPES UpdateOctober 18, 2013
✔ NPI 1063855211 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
License✔ Licensed in GA · PHHH000055
Definition
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.
Also ListedDurable Medical Equipment & Medical Supplies · Parenteral & Enteral NutritionTaxonomy 332BP3500X · License PHHH000055 (GA)
Also ListedPharmacy · Compounding PharmacyTaxonomy 3336C0004X · License PHHH000055 (GA)
Also ListedPharmacy · Home Infusion Therapy PharmacyTaxonomy 3336H0001X · License PHHH000055 (GA)
240 MILLEDGEVILLE RD, Gordon, GA 31031
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Other Names 1

Doing Business AsAngus Lake Vital Care

Other Identifiers 1

Medicaid003137168AGA

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Angus Lake Infusion Services's NPI number?

The NPI number for Angus Lake Infusion Services is 1063855211. It was assigned to this organization in the NPPES registry on April 8, 2013. The provider is doing business as Angus Lake Vital Care.

Where is Angus Lake Infusion Services located?

Angus Lake Infusion Services is located at 240 Milledgeville Rd Suite B, Gordon, GA 31031. The listed phone number is (478) 387-2399.

What is Angus Lake Infusion Services's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

When was this NPI record last updated?

The NPPES record for Angus Lake Infusion Services was last updated on October 18, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.