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General NPI Number Information
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NPI Number | 1124046198
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Entity Type | Organization
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Legal Business Name | LIFE ENHANCEMENT MEDICAL SERVICES PLLC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 190 COMMERCE BLVD
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City | STATESVILLE
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State | NC
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Zip | 28625-8526
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Country | US
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Telephone | 704-838-0516
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Fax | 704-838-0565
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Provider Business Mailing Address
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Address Line | 2632 FINES CREEK DR
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City | STATESVILLE
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State | NC
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Zip | 28625-4441
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Country | US
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Telephone | 704-838-0516
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Fax | 704-838-0565
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD PAVELOCK
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Credential | MD
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Telephone | 704-838-0516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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