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Organization
LIFE MEDICAL GROUP, LLC
Active
Organization
LIFE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADRIANNE MARIA RIDLEY-PAYNE M.D. (OWNER)
(813) 972-7979
Entity
Organization
Contact information
Practice address
14614 LIVINGSTON AVE, LUTZ, FL 33559-3101
(813) 972-7979
(813) 972-2424
Mailing address
14614 LIVINGSTON AVE, LUTZ, FL 33559-3101
(813) 972-7979
(813) 972-2424
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME82833
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12523258
CAQH
FL
Enumeration date
04/08/2013
Last updated
03/06/2016
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