Organization
LIFESTYLE MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARREL L ENGLE (MEMBER)
(325) 617-2181
Entity
Organization
Contact information
Practice address
2205 W BEAUREGARD AVE, SAN ANGELO, TX 76901-3701
(325) 617-2181
(325) 617-2479
Mailing address
2205 W BEAUREGARD AVE, SAN ANGELO, TX 76901-3701
(325) 617-2181
(325) 617-2479
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1954927
—
TX
01
—
532817
BC/BS
TX
Enumeration date
02/04/2008
Last updated
10/27/2010
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