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LIFE LINE TECHNOLOGIES, INC DBA XSTREMEMD
NPI 1629915962
Nurse Practitioner - Occupational Health in Broussard, LA

Active since May 04, 2026CLIA 45D2210554 · Waiver
1028 FORUM DR, BROUSSARD, LA 70518(337) 704-0891(337) 704-2974 Get Directions Write a Review

NPPES record last updated: May 4, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Life Line Technologies, Inc Dba Xstrememd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIFE LINE TECHNOLOGIES, INC DBA XSTREMEMD (NPI 1629915962), doing business as Xstrememd, is a healthcare organization registered as an occupational health in Broussard, Louisiana and active in the NPI registry since May 2026. The organization holds a CLIA Waiver certificate valid through January 21, 2027 and lists Michael Lyle Odinet, Cmo, as its authorized official.

NPPES Registry Identity

NPI1629915962
Entity TypeOrganization
Primary Taxonomy363LX0106X
Legal Business NameLIFE LINE TECHNOLOGIES, INC DBA XSTREMEMD
Location Address1028 FORUM DRBroussard, LA 70518-8060
Mailing Address1028 Forum DrBroussard, LA 70518-8060 · (337) 704-0891 · Fax (337) 704-2974
Phone(337) 704-0891
Fax(337) 704-2974
Organization SubpartNo
Authorized OfficialMichael Lyle OdinetCmo · (337) 704-0981
Enumeration DateMay 4, 2026
NPPES CertifiedMay 4, 2026
✔ NPI 1629915962 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Occupational HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LX0106X
1028 FORUM DR, Broussard, LA 70518
Open in Google Maps ↗

Other Names 1

Doing Business AsXstrememd

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2210554

Life Line Technologies, LLC Dba Xstrememd · Mentone, TX
Active · expires Jan 21, 2027
CLIA Number45D2210554
Laboratory TypeIndustrial
Certificate Effective DateJanuary 22, 2025
Certificate Expiration DateJanuary 21, 2027
Laboratory DirectorJoseph K. Pearson
Laboratory Phone(337) 704-0891
Laboratory LocationLife Line Technologies, LLC Dba Xstrememd248 County Road 407, Mentone, TX 79754
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

OCCUCARE INTERNATIONAL LAFAYETTE
Emergency Medicine
1028 FORUM DR
BROUSSARD, LA 70518
Lafayette Parish (337) 704-0891
MRS. LISA LOUISE SCHEXNIDER NP
Nurse Practitioner
1028 FORUM DR
BROUSSARD, LA 70518
Lafayette Parish (337) 326-9327
DR. JAYSON LEE EVERSGERD D.O.
Emergency Medicine
1028 FORUM DR
BROUSSARD, LA 70518
Lafayette Parish (774) 284-0496

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Life Line Technologies, Inc Dba Xstrememd's NPI number?

The NPI number for Life Line Technologies, Inc Dba Xstrememd is 1629915962. It was assigned to this organization in the NPPES registry on May 4, 2026. The provider is doing business as XstremeMD.

Where is Life Line Technologies, Inc Dba Xstrememd located?

Life Line Technologies, Inc Dba Xstrememd is located at 1028 Forum Dr, Broussard, LA 70518. The listed phone number is (337) 704-0891.

What is Life Line Technologies, Inc Dba Xstrememd's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Occupational Health, with taxonomy code 363LX0106X.

Does Life Line Technologies, Inc Dba Xstrememd hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2210554) is associated with this NPI, valid through January 21, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Life Line Technologies, Inc Dba Xstrememd was last updated on May 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.