| Life Enhancement Medical Services Pllc | |
|
190 Commerce Blvd Statesville NC 28625-8526 | |
| (704) 838-0516 | |
| (704) 838-0565 |
| Full Name | Life Enhancement Medical Services Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 190 Commerce Blvd, Statesville, North Carolina |
| Authorized Official Name and Position | Richard Pavelock (OWNER) |
| Authorized Official Contact | 7048380516 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Enhancement Medical Services Pllc 2632 Fines Creek Dr Statesville NC 28625-4441 Ph: (704) 838-0516 | Life Enhancement Medical Services Pllc 190 Commerce Blvd Statesville NC 28625-8526 Ph: (704) 838-0516 |
| NPI Number | 1124046198 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 04/19/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124046198 | NPI | - | NPPES |
| 5904288 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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