MEDICARE: LIFE

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	1001234	TX

General Provider Information

NPI Number	:	1639541642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE

Provider Business Mailing Address
First Line	:	4141 NORTH FWY
Second Line	:	SUITE 210
City	:	HOUSTON
State	:	TX
Zip	:	77022-4208
Country	:	US
Telephone Number	:	281-777-4330
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 NORTH FWY
Second Line	:	SUITE 215
City	:	HOUSTON
State	:	TX
Zip	:	77022-4208
Country	:	US
Telephone Number	:	281-777-4330
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SAMI HASSAN
Credential	:
Telephone Number	:	281-777-4330

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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Directions to “LIFE ” Practice Location

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