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General NPI Number Information
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NPI Number | 1235574740
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Entity Type | Organization
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Legal Business Name | LIFE IN A BLENDER FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 05/10/2013
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Last Update Date | 05/10/2013
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Provider Practice Location Address
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Address Line | 132 PROFESSIONAL PARK DR UNIT A
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City | CONWAY
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State | SC
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Zip | 29526-9268
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Country | US
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Telephone | 843-347-4900
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Fax | 843-347-4901
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Provider Business Mailing Address
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Address Line | 132 PROFESSIONAL PARK DR UNIT A
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City | CONWAY
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State | SC
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Zip | 29526-9268
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Country | US
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Telephone | 843-347-4900
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Fax | 843-347-4901
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | JOSEPH PAPOTTO
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Credential |
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Telephone | 843-347-4900
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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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