MEDICARE: DALLAS LIFE SUPPORT SYSTEMS, INC

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)	0030830	TX
2	332BX2000X	Oxygen Equipment & Supplies (DME)	0030830	TX

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780686998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS LIFE SUPPORT SYSTEMS, INC

Provider Business Mailing Address
First Line	:	7440 WHITEHALL ST
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76118-6426
Country	:	US
Telephone Number	:	817-284-7788
Fax Number	:	817-284-7780

Provider Business Practice Location Address
First Line	:	7440 WHITEHALL ST
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76118-6426
Country	:	US
Telephone Number	:	817-284-7788
Fax Number	:	817-284-7780

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SCOTT GARBER
Credential	:
Telephone Number	:	817-284-7788

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/16/2024

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Directions to “DALLAS LIFE SUPPORT SYSTEMS, INC ” Practice Location

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