1629238969 NPI number — LIFE FORCE, LLC

Table of content: (NPI 1629238969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629238969 NPI number — LIFE FORCE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE FORCE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LIFE FORCE 1
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629238969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PLAINS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65775-0708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-257-2104
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
975 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37403-2147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-778-6477
Provider Business Practice Location Address Fax Number:
423-778-6706
Provider Enumeration Date:
06/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HINTON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
417-256-0010

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)