Provider Demographics
NPI:1942573068
Name:LIFESTYLE DME GROUP, LLC
Entity Type:Organization
Organization Name:LIFESTYLE DME GROUP, LLC
Other - Org Name:LIFESTYLE MEDICAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-380-2110
Mailing Address - Street 1:2005 VALPARAISO ST
Mailing Address - Street 2:STE 115
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3330
Mailing Address - Country:US
Mailing Address - Phone:281-777-4330
Mailing Address - Fax:832-834-4665
Practice Address - Street 1:2005 VALPARAISO ST
Practice Address - Street 2:STE 115
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3330
Practice Address - Country:US
Practice Address - Phone:713-380-2110
Practice Address - Fax:832-834-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001234332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6764300001Medicare PIN