| Life Coordinated Commonwealth Pace Inc | |
|
201 E 11th St Benton KY 42025-1515 | |
| (855) 209-5451 | |
| Not Available |
| Full Name | Life Coordinated Commonwealth Pace Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 201 E 11th St, Benton, Kentucky |
| Authorized Official Name and Position | Nancy C Everitt (CEO) |
| Authorized Official Contact | 6153764677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Coordinated Commonwealth Pace Inc Po Box 2403 Brentwood TN 37024-2403 Ph: (615) 376-4677 | Life Coordinated Commonwealth Pace Inc 201 E 11th St Benton KY 42025-1515 Ph: (855) 209-5451 |
| NPI Number | 1487476636 |
|---|---|
| Provider Enumeration Date | 10/29/2024 |
| Last Update Date | 10/29/2024 |
| Medicare PECOS PAC ID | 8921540642 |
|---|---|
| Medicare Enrollment ID | O20250109000674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487476636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Sue Ann Gholson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093428245 PECOS PAC ID: 6406387372 Enrollment ID: I20241002002348 |
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