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General NPI Number Information
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NPI Number | 1750793113
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Entity Type | Organization
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Legal Business Name | LIVEWELL CENTERS LTD
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 3030 FRANK SCOTT PKWY W SUITE 1
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City | BELLEVILLE
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State | IL
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Zip | 62223-5014
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Country | US
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Telephone | 618-236-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 FRANK SCOTT PKWY W SUITE 1
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City | BELLEVILLE
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State | IL
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Zip | 62223-5014
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Country | US
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Telephone | 618-236-3600
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Fax |
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Authorized Official
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Title or Position | CHIEF OF STAFF
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Name | DR. PATRICK BRYAN KOMESHAK
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Credential | DC
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Telephone | 618-236-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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