Provider Demographics
NPI:1598752735
Name:LIFESTYLES INC
Entity Type:Organization
Organization Name:LIFESTYLES INC
Other - Org Name:LIFESTYLES ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KALINA
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:402-393-2354
Mailing Address - Street 1:15418 WEST CENTER RD,
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144
Mailing Address - Country:US
Mailing Address - Phone:402-393-2354
Mailing Address - Fax:402-393-2509
Practice Address - Street 1:15418 WEST CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144
Practice Address - Country:US
Practice Address - Phone:402-393-2354
Practice Address - Fax:402-393-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0541250Medicaid
IA0541250Medicaid