| Lifesource Of North Carolina | |
|
1208 E Pershing Blvd Cheyenne WY 82001-3230 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | General Practice |
| Location | 1208 E Pershing Blvd, Cheyenne, Wyoming |
| Authorized Official Name and Position | Peggy Baddour (PRESIDENT/OWNER) |
| Authorized Official Contact | 9107779165 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of North Carolina Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 742-9243 | Lifesource Of North Carolina 1208 E Pershing Blvd Cheyenne WY 82001-3230 Ph: (910) 742-9243 |
| NPI Number | 1386144418 |
|---|---|
| Provider Enumeration Date | 02/15/2018 |
| Last Update Date | 03/25/2021 |
| Certification Date | 03/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386144418 | NPI | - | NPPES |
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