Healthcare Provider Details

I. General information

NPI: 1730882390
Provider Name (Legal Business Name): LIFE MEDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 HOLDERRIETH BLVD STE 6
TOMBALL TX
77375-4553
US

IV. Provider business mailing address

PO BOX 550309
BIRMINGHAM AL
35255-0309
US

V. Phone/Fax

Practice location:
  • Phone: 281-351-6216
  • Fax:
Mailing address:
  • Phone: 205-631-8915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LONNIE BLAKE DORCEY
Title or Position: PRESIDENT
Credential:
Phone: 205-566-1674