Provider Demographics
NPI:1144046400
Name:LIFE SUPPORT MED SUPPLIES LLC
Entity type:Organization
Organization Name:LIFE SUPPORT MED SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-893-7461
Mailing Address - Street 1:8203 WILLOW PLACE DR S STE 145
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5528
Mailing Address - Country:US
Mailing Address - Phone:713-893-7461
Mailing Address - Fax:
Practice Address - Street 1:8203 WILLOW PLACE DR S STE 145
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5528
Practice Address - Country:US
Practice Address - Phone:713-893-7461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies