Healthcare Provider Details

I. General information

NPI: 1124046198
Provider Name (Legal Business Name): LIFE ENHANCEMENT MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 COMMERCE BLVD
STATESVILLE NC
28625-8526
US

IV. Provider business mailing address

2632 FINES CREEK DR
STATESVILLE NC
28625-4441
US

V. Phone/Fax

Practice location:
  • Phone: 704-838-0516
  • Fax: 704-838-0565
Mailing address:
  • Phone: 704-838-0516
  • Fax: 704-838-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD PAVELOCK
Title or Position: OWNER
Credential: MD
Phone: 704-838-0516