| Lifesource Prime Inc | |
|
1901 Libbie Ave Richmond VA 23226-1808 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Prime Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1901 Libbie Ave, Richmond, Virginia |
| Authorized Official Name and Position | Eryn M Robbins (VICE PRESIDENT OF OPERATIONS) |
| Authorized Official Contact | 9106222319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Prime Inc Po Box 740343 Atlanta GA 30374-0343 Ph: (910) 338-2877 | Lifesource Prime Inc 1901 Libbie Ave Richmond VA 23226-1808 Ph: (910) 742-9243 |
| NPI Number | 1548124159 |
|---|---|
| Provider Enumeration Date | 12/10/2025 |
| Last Update Date | 12/10/2025 |
| Certification Date | 12/10/2025 |
| Medicare PECOS PAC ID | 7810336385 |
|---|---|
| Medicare Enrollment ID | O20251230003234 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548124159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (NU) | Primary |
| Provider Name | Elena Antonia Morgan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649653197 PECOS PAC ID: 5193052090 Enrollment ID: I20240909004395 |
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