Provider Demographics
NPI:1225251564
Name:LIFESTYLES DISTRIBUTION CORP.
Entity Type:Organization
Organization Name:LIFESTYLES DISTRIBUTION CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SONGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-855-1212
Mailing Address - Street 1:5142 RICHTER ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2035
Mailing Address - Country:US
Mailing Address - Phone:361-855-1212
Mailing Address - Fax:361-855-7188
Practice Address - Street 1:5142 RICHTER ST BLDG A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-2035
Practice Address - Country:US
Practice Address - Phone:361-855-1212
Practice Address - Fax:361-855-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0044164332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid
GU=========Medicaid
TX=========Medicare ID - Type Unspecified
GU=========Medicaid