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General NPI Number Information
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NPI Number | 1770807919
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Entity Type | Organization
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Legal Business Name | LIFE CARE PHYSICIAN SERVICES, LLC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 3570 KEITH ST NW
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City | CLEVELAND
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State | TN
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Zip | 37312-4309
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Country | US
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Telephone | 423-473-5026
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Fax | 423-339-8323
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Provider Business Mailing Address
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Address Line | 3570 KEITH ST NW
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City | CLEVELAND
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State | TN
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Zip | 37312-4309
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Country | US
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Telephone | 423-473-5026
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Fax | 423-339-8323
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Authorized Official
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Title or Position | ASST. SECRETARY
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Name | CINDY S CROSS
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Credential |
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Telephone | 423-473-5867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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