Provider Demographics
NPI:1104531425
Name:LIVMOORE LLC
Entity type:Organization
Organization Name:LIVMOORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MR
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:LATRELL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-444-7273
Mailing Address - Street 1:1022 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:MARKS
Mailing Address - State:MS
Mailing Address - Zip Code:38646-1832
Mailing Address - Country:US
Mailing Address - Phone:662-444-7273
Mailing Address - Fax:
Practice Address - Street 1:979 HIGHWAY 6 W STE C&D
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9079
Practice Address - Country:US
Practice Address - Phone:662-444-7273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy