Provider Demographics
NPI:1932219920
Name:TOTAL LIFETIME CARE MEDICAL AFFILIATES INC.
Entity Type:Organization
Organization Name:TOTAL LIFETIME CARE MEDICAL AFFILIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-527-4852
Mailing Address - Street 1:1 MEMORY LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-9443
Mailing Address - Country:US
Mailing Address - Phone:330-527-4852
Mailing Address - Fax:330-527-4866
Practice Address - Street 1:1 MEMORY LN
Practice Address - Street 2:SUITE 200
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-9443
Practice Address - Country:US
Practice Address - Phone:330-527-4852
Practice Address - Fax:330-527-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000141541OtherANTHEM
OH2395242Medicaid
OH000000141541OtherANTHEM
E91225Medicare UPIN
OH1258340001Medicare NSC