NPIMap

Organization Active NPI

Selvaggi Investments

Doing business as Live Oak Professional Center

  • Rural Health Clinic/Center
  • Commerce, TX
National Provider Identifier
1508848029
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SELVAGGI INVESTMENTS
Doing business as
Live Oak Professional Center
Practice address
1705 Live Oak St
Commerce, TX 75428-2551
Phone
(903) 886-8818
Fax
(903) 886-8765
NPI assigned
Nov 18, 2005
Last updated
Apr 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

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

Authorized official

Name
Sue Nixson
Title
Office Manager
Phone
(903) 886-8818

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X H0803 TX
General Practice Physician 208D00000X K6628 TX
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1705 Live Oak St
Commerce, TX 75428-2551

Mailing address

1705 Live Oak St
Commerce, TX 75428-2551
Phone (903) 886-8818

Other identifiers 1

IdentifierTypeStateIssuer
111557802MedicaidTX

Other names 1

  • Live Oak Professional Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041007000421 TX Part B Supplier - Clinic/Group Practice 0042279846 Receives reassigned benefits from 1 practitioner
Practice locations: Commerce, TX

National Provider Directory

National Provider Directory

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Aug 1, 2019 Change of OwnershipThis provider was the seller Hunt Regional Medical PartnersCCN 453918, TX, NPI 1861958274

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680652800000",
    "number": "1508848029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 LIVE OAK ST",
            "city": "COMMERCE",
            "state": "TX",
            "postal_code": "754282551",
            "telephone_number": "903-886-8818",
            "fax_number": "903-886-8765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 LIVE OAK ST",
            "city": "COMMERCE",
            "state": "TX",
            "postal_code": "754282551",
            "telephone_number": "903-886-8818",
            "fax_number": "903-886-8765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELVAGGI INVESTMENTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-18",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A",
        "authorized_official_last_name": "NIXSON",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "903-886-8818"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H0803",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "K6628",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111557802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Live Oak Professional Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Commerce, TX

Sources for this page

Verify at the official NPI Registry.