Healthcare Provider Details

I. General information

NPI: 1396749917
Provider Name (Legal Business Name): LIVWELL COMMUNITY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 BROADWAY ST
PADUCAH KY
42001-7105
US

IV. Provider business mailing address

1903 BROADWAY ST.
PADUCAH KY
42001
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-8183
  • Fax: 247-044-8147
Mailing address:
  • Phone: 270-444-8183
  • Fax: 270-933-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONNA REEDER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 270-444-8183