Provider Demographics
NPI:1861151268
Name:LIVEWELL GASTROENTEROLOGY, PLLC
Entity type:Organization
Organization Name:LIVEWELL GASTROENTEROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DICHIARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-363-5515
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-0739
Mailing Address - Country:US
Mailing Address - Phone:859-363-5515
Mailing Address - Fax:859-545-5074
Practice Address - Street 1:23 TAFT HWY STE B
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-8121
Practice Address - Country:US
Practice Address - Phone:859-363-5515
Practice Address - Fax:859-545-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty