MEDICARE: INDEPENDANT LIFE STYLES

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	332B00000X	Durable Medical Equipment & Medical Supplies		VA

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

General Provider Information

NPI Number	:	1427096916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDANT LIFE STYLES

Provider Business Mailing Address
First Line	:	4880 S AMHERST HWY
Second Line	:
City	:	MADISON HEIGHTS
State	:	VA
Zip	:	24572-2478
Country	:	US
Telephone Number	:	434-846-7510
Fax Number	:	434-846-7189

Provider Business Practice Location Address
First Line	:	4880 S AMHERST HWY
Second Line	:
City	:	MADISON HEIGHTS
State	:	VA
Zip	:	24572-2478
Country	:	US
Telephone Number	:	434-846-7510
Fax Number	:	434-846-7189

Authorized Official
Title or Position	:	GENERAL MANAGER/ OWNER
Name	:	CARRIE FRANCES WEEKS
Credential	:
Telephone Number	:	434-846-7510

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	11/04/2008

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Directions to “INDEPENDANT LIFE STYLES ” Practice Location

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