| Life Well Health Services | |
|
2408 Susannah St Ste 3 Johnson City TN 37601-1765 | |
| (877) 338-0118 | |
| (423) 268-2011 |
| Full Name | Life Well Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 2408 Susannah St Ste 3, Johnson City, Tennessee |
| Authorized Official Name and Position | Philip Blake Musick (OWNER/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 2765917035 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Well Health Services 288 Laurel Cyn Johnson City TN 37615-4726 Ph: (877) 338-0118 | Life Well Health Services 2408 Susannah St Ste 3 Johnson City TN 37601-1765 Ph: (877) 338-0118 |
| NPI Number | 1316604515 |
|---|---|
| Provider Enumeration Date | 11/22/2021 |
| Last Update Date | 08/26/2025 |
| Certification Date | 08/26/2025 |
| Medicare PECOS PAC ID | 5294127601 |
|---|---|
| Medicare Enrollment ID | O20220114002055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316604515 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Primary |
| 3336C0002X | Pharmacy - Clinic Pharmacy | (NU) | Secondary |
| Provider Name | Jason Della Vecchia |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1770554982 PECOS PAC ID: 6901886159 Enrollment ID: I20120319000381 |
| Provider Name | Laura Ellen Purdy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093058463 PECOS PAC ID: 9133556624 Enrollment ID: I20200221002266 |
| Provider Name | Joel Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194783472 PECOS PAC ID: 7517943327 Enrollment ID: I20221027002153 |
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