MEDICARE: LIFELINE MEDICAL SUPPLIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1700673563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	11133 SHADY TRL # 262
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11133 SHADY TRL # 262
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-4617
Country	:	US
Telephone Number	:	945-206-0473
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RAFFAY AAMIR
Credential	:
Telephone Number	:	945-206-0473

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	07/23/2025

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