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General NPI Number Information
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NPI Number | 1679516348
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Entity Type | Organization
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Legal Business Name | TOTAL LIFE CARE, LLC
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4491 BENT BROS. BLVD
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City | COLORADO CITY
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State | CO
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Zip | 81019
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Country | US
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Telephone | 719-676-2273
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Fax | 719-676-3297
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Provider Business Mailing Address
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Address Line | PO BOX 19873
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City | COLORADO CITY
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State | CO
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Zip | 81019-0873
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Country | US
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Telephone | 719-676-2273
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Fax | 719-676-3297
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | GRADY KING SNYDER JR.
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Credential | M.D.
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Telephone | 719-676-2273
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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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