Organization
LIFE LINE MEDICAL SUPPLY CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRANK RUSSELL NICHOLSON (PRESIDENT)
(214) 522-4351
Entity
Organization
Contact information
Practice address
805 W PRICE RD, STE C-1, BROWNSVILLE, TX 78520-8745
(956) 504-1300
Mailing address
4424 VANDELIA ST, DALLAS, TX 75219-2047
(214) 522-4351
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
05/27/2005
Last updated
11/21/2011
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