Healthcare Provider Details

I. General information

NPI: 1659937977
Provider Name (Legal Business Name): EZHEALTHLIVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W MAIN ST STE 213B
LANCASTER OH
43130-3763
US

IV. Provider business mailing address

PO BOX 2389
LANCASTER OH
43130-5389
US

V. Phone/Fax

Practice location:
  • Phone: 888-417-6543
  • Fax:
Mailing address:
  • Phone: 740-675-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY R CLAUSS
Title or Position: CEO
Credential:
Phone: 888-417-6543