MEDICARE: LIVING HEALTH CENTER, 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	208D00000X	General Practice Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1508202110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	3434 HONDO PASS DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-1015
Country	:	US
Telephone Number	:	915-755-2582
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 HONDO PASS DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-1015
Country	:	US
Telephone Number	:	915-755-2582
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LORY HELMICK
Credential	:
Telephone Number	:	915-755-2582

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/27/2014

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