| Lifeway Inc | |
|
5333 N Dixie Hwy Suite 110 Oakland Park FL 33334-3414 | |
| (954) 772-8554 | |
| (954) 772-9662 |
| Full Name | Lifeway Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 5333 N Dixie Hwy, Oakland Park, Florida |
| Authorized Official Name and Position | Marah J. Lee (PRESIDENT) |
| Authorized Official Contact | 9547728554 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeway Inc 5333 N Dixie Hwy Suite 110 Oakland Park FL 33334-3414 Ph: (954) 772-8554 | Lifeway Inc 5333 N Dixie Hwy Suite 110 Oakland Park FL 33334-3414 Ph: (954) 772-8554 |
| NPI Number | 1568477156 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 06/21/2018 |
| Medicare PECOS PAC ID | 6406863034 |
|---|---|
| Medicare Enrollment ID | O20060307000606 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568477156 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | OS6563 (Florida) | Primary |
| Provider Name | Scott Allen Hall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972578219 PECOS PAC ID: 6507842507 Enrollment ID: I20040629001075 |
| Provider Name | Marah Lee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518923010 PECOS PAC ID: 3577570126 Enrollment ID: I20090713000538 |
| Provider Name | Vincent Tyson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003245457 PECOS PAC ID: 1355572520 Enrollment ID: I20200825001526 |
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