MEDICARE: L5 MEDICAL HOLDINGS LLC

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1336491877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L5 MEDICAL HOLDINGS LLC

Provider Business Mailing Address
First Line	:	10 RESOLUTE LN STE 200
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-6608
Country	:	US
Telephone Number	:	843-352-9478
Fax Number	:	888-977-2989

Provider Business Practice Location Address
First Line	:	4262 S AMHERST HWY STE 200
Second Line	:
City	:	MADISON HEIGHTS
State	:	VA
Zip	:	24572-5363
Country	:	US
Telephone Number	:	434-528-4640
Fax Number	:	888-977-2989

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN GREGORY BARNES
Credential	:
Telephone Number	:	843-270-1687

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	09/20/2019

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