Organization
LIFE ENHANCEMENT MEDICAL SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD PAVELOCK MD (OWNER)
(704) 838-0516
Entity
Organization
Contact information
Practice address
190 COMMERCE BLVD, STATESVILLE, NC 28625-8526
(704) 838-0516
(704) 838-0565
Mailing address
2632 FINES CREEK DR, STATESVILLE, NC 28625-4441
(704) 838-0516
(704) 838-0565
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5904288
—
NC
Enumeration date
07/18/2006
Last updated
04/19/2017
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