MEDICARE: LIFELINE PPE

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
2	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1912738436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE PPE

Provider Business Mailing Address
First Line	:	1181 S SUMTER BLVD STE 317
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-2335
Country	:	US
Telephone Number	:	800-940-0661
Fax Number	:

Provider Business Practice Location Address
First Line	:	3866 JULNAR AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286
Country	:	US
Telephone Number	:	800-940-0661
Fax Number	:

Authorized Official
Title or Position	:	OWNER/AUTHORIZED OFFICIAL
Name	:	MICHAEL BORZA
Credential	:
Telephone Number	:	800-940-0661

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	12/06/2024

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Directions to “LIFELINE PPE ” Practice Location

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