MEDICARE: HEALTHLINE MEDICAL EQUIPMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	0046415	TX
2	332BX2000X	Oxygen Equipment & Supplies (DME)	0046415	TX
3	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184623688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHLINE MEDICAL EQUIPMENT LLC

Provider Business Mailing Address
First Line	:	555 E NORTH LN STE 5075
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2490
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 SANTA FE DR STE 300
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-6523
Country	:	US
Telephone Number	:	682-219-0533
Fax Number	:	817-594-6054

Authorized Official
Title or Position	:	CCO
Name	:	WENDY RUSSALESI
Credential	:
Telephone Number	:	484-246-9499

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/21/2026

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Directions to “HEALTHLINE MEDICAL EQUIPMENT LLC ” Practice Location

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