Organization
LIFE LINE MEDICAL EQUIPMENT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SYLVIA DIANNE BASTOW (PRESIDENT)
(337) 239-9100
Entity
Organization
Contact information
Practice address
110 E LULA ST, SUITE B, LEESVILLE, LA 71446-4363
(337) 239-9100
(337) 239-9222
Mailing address
110 E LULA ST, SUITE B, LEESVILLE, LA 71446-4363
(337) 239-9100
(337) 239-9222
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
9086059-001 0
LA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
9086059-001 0
LA
332BX2000X
Oxygen Equipment & Supplies (DME)
9086059-001 0
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1671304
—
LA
01
—
B7916
BCBS IDENTIFIER
LA
Enumeration date
12/19/2006
Last updated
04/20/2008
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