Organization
LIVEWELL MEDICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT STALEY (PRESIDENT)
(704) 494-8849
Entity
Organization
Contact information
Practice address
8421 OLD STATESVILLE RD, SUITE 18, CHARLOTTE, NC 28269-1808
(704) 494-8849
(704) 494-8850
Mailing address
8421 OLD STATESVILLE RD, SUITE 18, CHARLOTTE, NC 28269-1808
(704) 494-8849
(704) 494-8850
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7705319
—
NC
05
—
DE2703
—
SC
Enumeration date
09/14/2006
Last updated
05/09/2012
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