Active NPI
Life Enhancement Medical Services PLLC
- Addiction Medicine (Psychiatry & Neurology) Physician
- Statesville, NC
National Provider Identifier
1124046198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Medicine (Psychiatry & Neurology) Physician
- Legal business name
- LIFE ENHANCEMENT MEDICAL SERVICES PLLC
- Practice address
- 2632 Fines Creek Dr
Statesville, NC 28625-4441 - Phone
- (704) 880-8665
- Fax
- (704) 838-0565
- NPI assigned
- Jul 18, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Richard Pavelock, MD
- Title
- Owner
- Phone
- (704) 838-0516
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | |||
| Internal Medicine Physician | 207R00000X | |||
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | Primary |
Addresses
Primary practice location
2632 Fines Creek Dr
Statesville, NC 28625-4441
Mailing address
2632 Fines Creek Dr
Statesville, NC 28625-4441
Phone (704) 838-0516
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5904288 | Medicaid | NC |
National Provider Directory
National Provider DirectoryLocations
28 Pisgah View Ave
Asheville, NC 28803
Phone (828) 274-8368
5300 Highway 200
Concord, NC 28025
Phone (704) 788-2304
176 Wildcat Rd
Deep Gap, NC 28618
Phone (828) 262-4540
1107A E Mountain St
Kernersville, NC 27284
Phone (704) 636-8662
9929 Albemarle Rd
Mint Hill, NC 28227
Phone (704) 838-0516
190 Commerce Blvd
Statesville, NC 28625
Phone (704) 838-0516
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1782864000000",
"number": "1124046198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2632 FINES CREEK DR",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286254441",
"telephone_number": "704-838-0516",
"fax_number": "704-838-0565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2632 FINES CREEK DR",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286254441",
"telephone_number": "704-880-8665",
"fax_number": "704-838-0565"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LIFE ENHANCEMENT MEDICAL SERVICES PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-18",
"last_updated": "2026-07-01",
"certification_date": "2026-07-01",
"status": "A",
"authorized_official_last_name": "PAVELOCK",
"authorized_official_first_name": "RICHARD",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "704-838-0516",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084A0401X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Addiction Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5904288",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Statesville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.