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General NPI Number Information
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NPI Number | 1932537776
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Entity Type | Organization
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Legal Business Name | LIVE WELL MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 1409 KINGSLEY AVE BUILDING 2
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City | ORANGE PARK
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State | FL
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Zip | 32073-4537
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Country | US
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Telephone | 904-621-8043
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Fax | 904-621-8068
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Provider Business Mailing Address
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Address Line | 1409 KINGSLEY AVE BUILDING 2
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City | ORANGE PARK
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State | FL
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Zip | 32073-4537
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Country | US
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Telephone | 904-621-8043
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Fax | 904-621-8068
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Authorized Official
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Title or Position | MANAGER
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Name | MICHELLE CARTER
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Credential |
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Telephone | 904-621-8043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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