Healthcare Provider Details

I. General information

NPI: 1457667750
Provider Name (Legal Business Name): LIVI MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 N CENTRAL AVE STE 1200
PHOENIX AZ
85012-2745
US

IV. Provider business mailing address

717 N HARWOOD ST STE 550
DALLAS TX
75201-6540
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-0606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41583
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number0523
License Number StateAZ

VIII. Authorized Official

Name: ANDREA F BOHANNON
Title or Position: PRESIDENT, CEO & ASST SECRETARY
Credential:
Phone: 214-628-9950