| Livewell Passport Of Va Llc | |
|
13553 Midlothian Tpke Midlothian VA 23113-4261 | |
| (804) 229-1554 | |
| (844) 777-1754 |
| Full Name | Livewell Passport Of Va Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 13553 Midlothian Tpke, Midlothian, Virginia |
| Authorized Official Name and Position | Jeremiah D Fabry (MANAGER) |
| Authorized Official Contact | 8042291554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Livewell Passport Of Va Llc 15801 Swindon Way Midlothian VA 23112-5531 Ph: (804) 229-1554 | Livewell Passport Of Va Llc 13553 Midlothian Tpke Midlothian VA 23113-4261 Ph: (804) 229-1554 |
| NPI Number | 1366136418 |
|---|---|
| Provider Enumeration Date | 06/02/2023 |
| Last Update Date | 06/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366136418 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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