| Life Medical Group, Llc | |
|
14614 Livingston Ave Lutz FL 33559-3101 | |
| (813) 972-7979 | |
| (813) 972-2424 |
| Full Name | Life Medical Group, Llc |
|---|---|
| Speciality | General Practice |
| Location | 14614 Livingston Ave, Lutz, Florida |
| Authorized Official Name and Position | Adrianne Maria Ridley-payne (OWNER) |
| Authorized Official Contact | 8139727979 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Medical Group, Llc 14614 Livingston Ave Lutz FL 33559-3101 Ph: (813) 972-7979 | Life Medical Group, Llc 14614 Livingston Ave Lutz FL 33559-3101 Ph: (813) 972-7979 |
| NPI Number | 1922441054 |
|---|---|
| Provider Enumeration Date | 04/08/2013 |
| Last Update Date | 03/06/2016 |
| Medicare PECOS PAC ID | 8820235526 |
|---|---|
| Medicare Enrollment ID | O20130523000090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922441054 | NPI | - | NPPES |
| 12523258 | Other | FL | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ME82833 (Florida) | Primary |
| Provider Name | Adrianne M Ridley Payne |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1235355074 PECOS PAC ID: 4284872722 Enrollment ID: I20130523000160 |
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