MEDICARE: LIFE LINE TECHNOLOGIES, INC DBA XSTREMEMD

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	363LX0106X	Occupational Health Nurse Practitioner

General Provider Information

NPI Number	:	1629915962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE LINE TECHNOLOGIES, INC DBA XSTREMEMD

Provider Business Mailing Address
First Line	:	1028 FORUM DR
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-8060
Country	:	US
Telephone Number	:	337-704-0891
Fax Number	:	337-704-2974

Provider Business Practice Location Address
First Line	:	1028 FORUM DR
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-8060
Country	:	US
Telephone Number	:	337-704-0891
Fax Number	:	337-704-2974

Authorized Official
Title or Position	:	CMO
Name	:	MICHAEL LYLE ODINET
Credential	:	MD
Telephone Number	:	337-704-0981

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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