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NPI Code Detail

MEDICARE: LIFELONG DIGITAL HEALTH INC

MEDICARE: LIFELONG DIGITAL HEALTH INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1245809649
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFELONG DIGITAL HEALTH INC
Provider Business Mailing Address
First Line : PO BOX 591611
Second Line :
City : HOUSTON
State : TX
Zip : 77259-1611
Country : US
Telephone Number : 346-408-2705
Fax Number :
Provider Business Practice Location Address
First Line : 2401 FOUNTAIN VIEW DR STE 461
Second Line :
City : HOUSTON
State : TX
Zip : 77057-4833
Country : US
Telephone Number : 346-408-2705
Fax Number :
Authorized Official
Title or Position : CEO
Name : JAMES DRURY
Credential :
Telephone Number : 209-900-3142
Provider Enumeration Date : 06/21/2021
Last Update Date : 06/21/2021

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Directions to “LIFELONG DIGITAL HEALTH INC ” Practice Location

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