Provider Demographics
NPI:1235666413
Name:LIFETIME MEDICAL EQUIPMENT AND SUPPLIES
Entity Type:Organization
Organization Name:LIFETIME MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-787-0072
Mailing Address - Street 1:5200 PAIGE RD
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2121
Mailing Address - Country:US
Mailing Address - Phone:972-787-0072
Mailing Address - Fax:972-694-0286
Practice Address - Street 1:5200 PAIGE RD
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2121
Practice Address - Country:US
Practice Address - Phone:972-787-0072
Practice Address - Fax:972-694-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies