Provider Demographics
NPI:1194001495
Name:EZ LIFE MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:EZ LIFE MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOSS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-450-0295
Mailing Address - Street 1:4697 GLEN HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2185
Mailing Address - Country:US
Mailing Address - Phone:214-415-2914
Mailing Address - Fax:214-570-1620
Practice Address - Street 1:101 S COIT RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5743
Practice Address - Country:US
Practice Address - Phone:214-450-0295
Practice Address - Fax:214-570-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies