Healthcare Provider Details

I. General information

NPI: 1689671836
Provider Name (Legal Business Name): LIFE MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N MCCOLL RD STE A
MCALLEN TX
78501-9310
US

IV. Provider business mailing address

PO BOX 550309
BIRMINGHAM AL
35255-0309
US

V. Phone/Fax

Practice location:
  • Phone: 956-994-3600
  • Fax: 956-994-3612
Mailing address:
  • Phone: 205-566-1674
  • Fax: 205-278-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0079549A
License Number StateTX

VIII. Authorized Official

Name: MR. LONNIE B DORCEY
Title or Position: PRESIDENT
Credential:
Phone: 205-566-1674