Provider Demographics
NPI:1225197031
Name:TOTAL LIFE CARE, PLLC
Entity type:Organization
Organization Name:TOTAL LIFE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM
Authorized Official - Phone:270-554-3904
Mailing Address - Street 1:2850 LONE OAK RD
Mailing Address - Street 2:BAYLEY SQUARE, SUITE 4
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8043
Mailing Address - Country:US
Mailing Address - Phone:270-205-1394
Mailing Address - Fax:270-534-8928
Practice Address - Street 1:2850 LONE OAK RD
Practice Address - Street 2:BAYLEY SQUARE, SUITE 4
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8043
Practice Address - Country:US
Practice Address - Phone:270-554-3904
Practice Address - Fax:270-534-8928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65902389Medicaid
KY06348Medicare ID - Type Unspecified