Provider Demographics
NPI:1871909713
Name:SCREENING FOR LIFE LLC
Entity type:Organization
Organization Name:SCREENING FOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ETAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-337-1000
Mailing Address - Street 1:PO BOX 2754
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-2754
Mailing Address - Country:US
Mailing Address - Phone:325-692-4410
Mailing Address - Fax:325-232-7814
Practice Address - Street 1:6410 BUFFALO GAP RD # C
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-6055
Practice Address - Country:US
Practice Address - Phone:325-692-4410
Practice Address - Fax:325-232-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2025-01-02
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
TX316060803Medicaid
TX217108100OtherFIRSTCARE
TX335095Medicare UPIN