Healthcare Provider Details

I. General information

NPI: 1275314148
Provider Name (Legal Business Name): LIV SPECIALTY CARE CT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47010 COMMUNITY PLZ STE 150
STERLING VA
20164-1896
US

IV. Provider business mailing address

PO BOX 53304
PHOENIX AZ
85072-3304
US

V. Phone/Fax

Practice location:
  • Phone: 703-977-6779
  • Fax: 703-202-5685
Mailing address:
  • Phone: 844-614-2354
  • Fax: 844-278-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WOODRUFF HALL BAUM
Title or Position: CEO
Credential:
Phone: 646-568-0193