MEDICARE: QUALITY OF LIFE HEALTHCARE 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	208VP0000X	Pain Medicine Physician
2	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1558632216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY OF LIFE HEALTHCARE INC.

Provider Business Mailing Address
First Line	:	302 WESLEY ST STE 3
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1741
Country	:	US
Telephone Number	:	423-282-0561
Fax Number	:	423-282-0563

Provider Business Practice Location Address
First Line	:	302 WESLEY ST STE 3
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1741
Country	:	US
Telephone Number	:	423-282-0561
Fax Number	:	423-282-0563

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES FAMOYIN
Credential	:	MD
Telephone Number	:	423-431-8889

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	08/24/2023

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