| Life Care Physician Services, Llc | |
|
3570 Keith St Nw Cleveland TN 37312-4309 | |
| (423) 473-5026 | |
| (423) 339-8323 |
| Full Name | Life Care Physician Services, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3570 Keith St Nw, Cleveland, Tennessee |
| Authorized Official Name and Position | Cindy S Cross (ASST. SECRETARY) |
| Authorized Official Contact | 4234735867 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Care Physician Services, Llc 3570 Keith St Nw Cleveland TN 37312-4309 Ph: (423) 473-5026 | Life Care Physician Services, Llc 3570 Keith St Nw Cleveland TN 37312-4309 Ph: (423) 473-5026 |
| NPI Number | 1770807919 |
|---|---|
| Provider Enumeration Date | 03/17/2010 |
| Last Update Date | 10/20/2021 |
| Medicare PECOS PAC ID | 5395861306 |
|---|---|
| Medicare Enrollment ID | O20100928000490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770807919 | NPI | - | NPPES |
| Provider Name | Eduardo Diaz |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1902043771 PECOS PAC ID: 6305974601 Enrollment ID: I20100506000853 |
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