Provider Demographics
NPI:1609998442
Name:FAMILY LIFE MEDICAL AND PROSTHETICS LLC
Entity Type:Organization
Organization Name:FAMILY LIFE MEDICAL AND PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:270-217-0798
Mailing Address - Street 1:300 MAPLE ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2540
Mailing Address - Country:US
Mailing Address - Phone:270-217-0798
Mailing Address - Fax:
Practice Address - Street 1:300 MAPLE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2540
Practice Address - Country:US
Practice Address - Phone:270-217-0798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105540332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5285910002Medicare ID - Type Unspecified