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General NPI Number Information
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NPI Number | 1043827694
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Entity Type | Organization
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Legal Business Name | MEDLIFE SUPPLY LLC
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 1495 FOREST HILL BLVD STE C1
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-6073
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Country | US
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Telephone | 877-401-2142
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Fax | 561-770-3593
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Provider Business Mailing Address
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Address Line | 1495 FOREST HILL BLVD STE C1
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City | WEST PALM BEACH
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State | FL
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Zip | 33406-6073
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Country | US
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Telephone | 877-401-2142
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Fax | 561-770-3593
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL JAMES INGRAM III
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Credential |
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Telephone | 877-401-2142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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