Provider Demographics
NPI:1346950433
Name:LIVING WATERS FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:LIVING WATERS FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-900-5313
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-0602
Mailing Address - Country:US
Mailing Address - Phone:301-900-5313
Mailing Address - Fax:301-235-1590
Practice Address - Street 1:1260 MARYLAND AVE STE 114
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7248
Practice Address - Country:US
Practice Address - Phone:301-900-5313
Practice Address - Fax:301-235-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty