Ilivewell Nutrition Therpay, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

DT82817 Issued in TX

Legal business name

ILIVEWELL NUTRITION THERPAY, LLC

Practice address

801 Ranch Road 620 S
Lakeway, TX 78734-5316

Phone

(512) 547-9274

NPI assigned

Oct 5, 2013

Organization subpart

Yes

Parent organization

PRACTICE FUSIONAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adrien Paczosa

Title

President

Phone

(512) 547-9274

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380931200000",
    "number": "1306273347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 RANCH ROAD 620 S",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787345316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 RANCH ROAD 620 S",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787345316",
            "telephone_number": "512-547-9274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILIVEWELL NUTRITION THERPAY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRACTICE FUSION",
        "enumeration_date": "2013-10-05",
        "last_updated": "2013-10-05",
        "status": "A",
        "authorized_official_last_name": "PACZOSA",
        "authorized_official_first_name": "ADRIEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-547-9274"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "DT82817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Lakeway, TX
• Providers in Lakeway, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.