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General NPI Number Information
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NPI Number | 1104531425
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Entity Type | Organization
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Legal Business Name | LIVMOORE LLC
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Dates
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Enumeration Date | 01/20/2023
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 979 HIGHWAY 6 W STE C&D
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City | OXFORD
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State | MS
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Zip | 38655-9079
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Country | US
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Telephone | 662-444-7273
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 MARTIN LUTHER KING DR
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City | MARKS
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State | MS
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Zip | 38646-1832
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Country | US
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Telephone | 662-444-7273
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Fax |
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Authorized Official
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Title or Position | MR
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Name | LONNIE LATRELL MOORE
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Credential |
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Telephone | 662-444-7273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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