Provider Demographics
NPI:1346639697
Name:LIFE LINE SUPPLY CO
Entity Type:Organization
Organization Name:LIFE LINE SUPPLY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-522-4351
Mailing Address - Street 1:1545 W MOCKINGBIRD LN
Mailing Address - Street 2:STE 1020
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5014
Mailing Address - Country:US
Mailing Address - Phone:214-522-4351
Mailing Address - Fax:866-332-9151
Practice Address - Street 1:1545 W MOCKINGBIRD LN
Practice Address - Street 2:STE 1020
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5014
Practice Address - Country:US
Practice Address - Phone:214-522-4351
Practice Address - Fax:866-332-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000407332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies