MEDICARE: LIVEIT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	CPED2175	MO

General Provider Information

NPI Number	:	1699944793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVEIT, LLC

Provider Business Mailing Address
First Line	:	1018 MAIN ST
Second Line	:	SUITE B
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3033
Country	:	US
Telephone Number	:	573-348-6767
Fax Number	:	573-348-6767

Provider Business Practice Location Address
First Line	:	1018 MAIN ST
Second Line	:	SUITE B
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3033
Country	:	US
Telephone Number	:	573-348-6767
Fax Number	:	573-348-6767

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUSAN E MITCHELL
Credential	:	C.PED
Telephone Number	:	573-348-6767

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	03/31/2010

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