Organization Active NPI

Life Line Technologies, Inc Dba Xstrememd

Doing business as XstremeMD

  • Occupational Health Nurse Practitioner
  • Broussard, LA
National Provider Identifier
1629915962
Registry record updated May 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Health Nurse PractitionerTaxonomy code 363LX0106X
Legal business name
LIFE LINE TECHNOLOGIES, INC DBA XSTREMEMD
Doing business as
XstremeMD
Practice address
1028 Forum Dr
Broussard, LA 70518-8060
Phone
(337) 704-0891
Fax
(337) 704-2974
NPI assigned
May 4, 2026
Last updated
May 4, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Lyle Odinet, MDNPI 1306861646
Title
Cmo
Phone
(337) 704-0981

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Health Nurse Practitioner 363LX0106X Primary

Addresses

Primary practice location

1028 Forum Dr
Broussard, LA 70518-8060

Mailing address

1028 Forum Dr
Broussard, LA 70518-8060
Phone (337) 704-0891

Other names 1

  • XstremeMD Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1777852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777852800000",
    "number": "1629915962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 FORUM DR",
            "city": "BROUSSARD",
            "state": "LA",
            "postal_code": "705188060",
            "telephone_number": "337-704-0891",
            "fax_number": "337-704-2974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 FORUM DR",
            "city": "BROUSSARD",
            "state": "LA",
            "postal_code": "705188060",
            "telephone_number": "337-704-0891",
            "fax_number": "337-704-2974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE LINE TECHNOLOGIES, INC DBA XSTREMEMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-05-04",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A",
        "authorized_official_last_name": "ODINET",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LYLE",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "337-704-0981",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "XstremeMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broussard, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.