# LIVE OAK HMA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shands Live Oak Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669568499
- **Authorized official:** PAULA LALOR (DIRECTOR/DELEGATED OFFICIAL)
- **Authorized official phone:** (615) 925-4565

## Contact information

- **Practice address:** 1426 CANYON AVE NE, UNIT B, LIVE OAK, FL 32064-4832
- **Practice address phone:** (386) 208-0537
- **Mailing address:** 1426 CANYON AVE NE, UNIT B, LIVE OAK, FL 32064-4832
- **Mailing address phone:** (386) 208-0537

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 4314 | FL | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 02/23/2018