Provider Demographics
NPI:1235574740
Name:LIFE IN A BLENDER FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:LIFE IN A BLENDER FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-347-4900
Mailing Address - Street 1:132 PROFESSIONAL PARK DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9268
Mailing Address - Country:US
Mailing Address - Phone:843-347-4900
Mailing Address - Fax:843-347-4901
Practice Address - Street 1:132 PROFESSIONAL PARK DR UNIT A
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9268
Practice Address - Country:US
Practice Address - Phone:843-347-4900
Practice Address - Fax:843-347-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty