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General NPI Number Information
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NPI Number | 1962599126
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Entity Type | Organization
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Legal Business Name | LIFESTYLE MEDICAL SUPPLY
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1413 S PATRICK DR SUITE 3
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City | INDIAN HARBOR BEACH
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State | FL
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Zip | 32937-4373
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Country | US
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Telephone | 321-779-4300
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Fax | 321-821-1989
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Provider Business Mailing Address
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Address Line | 1413 S PATRICK DR SUITE 3
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City | INDIAN HARBOR BEACH
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State | FL
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Zip | 32937-4373
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Country | US
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Telephone | 321-779-4300
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Fax | 321-821-1989
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Authorized Official
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Title or Position | OWNER
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Name | MR. TODD MCLAUGHLIN
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Credential |
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Telephone | 321-779-4300
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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 | 1580136790602
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License Number State | FL
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