Provider Demographics
NPI:1912403551
Name:MEDLIFE TEXAS INC
Entity Type:Organization
Organization Name:MEDLIFE TEXAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HIBAH
Authorized Official - Middle Name:ZEHRA
Authorized Official - Last Name:KAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-569-0745
Mailing Address - Street 1:805 STANFORD DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4412
Mailing Address - Country:US
Mailing Address - Phone:214-228-7246
Mailing Address - Fax:
Practice Address - Street 1:608 HWY 50
Practice Address - Street 2:
Practice Address - City:LADONIA
Practice Address - State:TX
Practice Address - Zip Code:75449
Practice Address - Country:US
Practice Address - Phone:214-228-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA