MEDICARE: LIVE OAK PEST CONTROL, 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
1	253Z00000X	In Home Supportive Care Agency	JB760	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407273220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE OAK PEST CONTROL, INC.

Provider Business Mailing Address
First Line	:	17856 US HIGHWAY 129
Second Line	:
City	:	MC ALPIN
State	:	FL
Zip	:	32062-2561
Country	:	US
Telephone Number	:	386-362-3887
Fax Number	:	386-364-3529

Provider Business Practice Location Address
First Line	:	17856 US HIGHWAY 129
Second Line	:
City	:	MC ALPIN
State	:	FL
Zip	:	32062-2561
Country	:	US
Telephone Number	:	386-362-3887
Fax Number	:	386-364-3529

Authorized Official
Title or Position	:	VP
Name	:	MS. MELISSA M LEE
Credential	:
Telephone Number	:	386-362-3887

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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