=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316804446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFECARE SUPPORTIVE MEDICINE INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2026
-----------------------------------------------------
Last Update Date | 01/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 PHYSICIANS DR
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28401-7335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-796-8000
-----------------------------------------------------
Fax | 910-796-8000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 PHYSICIANS DR
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28401-7335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-796-8000
-----------------------------------------------------
Fax | 910-796-8000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | TIMOTHY KING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-796-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------