Provider Demographics
NPI:1457667750
Name:LIVI MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:LIVI MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRODDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-478-6830
Mailing Address - Street 1:6380 E THOMAS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7033
Mailing Address - Country:US
Mailing Address - Phone:480-607-0606
Mailing Address - Fax:480-498-3725
Practice Address - Street 1:6380 E THOMAS RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7033
Practice Address - Country:US
Practice Address - Phone:480-607-0606
Practice Address - Fax:480-498-3725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41583207Q00000X
AZ0523261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty