Healthcare Provider Details

I. General information

NPI: 1003800707
Provider Name (Legal Business Name): LIFE SUPPORT SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 ROOSEVELT BLVD
CLEARWATER FL
33760-1926
US

IV. Provider business mailing address

2965 ROOSEVELT BLVD
CLEARWATER FL
33760-1926
US

V. Phone/Fax

Practice location:
  • Phone: 800-659-8151
  • Fax: 727-531-9552
Mailing address:
  • Phone: 800-659-8151
  • Fax: 727-531-9552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License NumberHCC3742
License Number StateFL

VIII. Authorized Official

Name: MR. RICHARD DEAN EDWARDS
Title or Position: OWNER/CEO
Credential: PA
Phone: 800-659-8151