NPIMap

Organization Active NPI

Live Oak Hma, LLC

  • Rural Health Clinic/Center
  • Live Oak, FL
National Provider Identifier
1669568499
Registry record updated Feb 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
4314 Issued in FL
Legal business name
LIVE OAK HMA, LLC
Practice address
1426 Canyon Ave NE
Unit B
Live Oak, FL 32064-4832
Phone
(386) 208-0537
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2018

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

Authorized official

Name
Paula Lalor
Title
Director/Delegated Official
Phone
(615) 925-4565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 4314 FL Primary

Addresses

Primary practice location

1426 Canyon Ave NE
Unit B
Live Oak, FL 32064-4832

Mailing address

1426 Canyon Ave NE
Unit B
Live Oak, FL 32064-4832
Phone (386) 208-0537

Other identifiers 3

IdentifierTypeStateIssuer
660120100MedicaidFL
CE9137OtherFLMEDICARE RAIL ROAD
660120101MedicaidFL

Other names 1

  • Shands Live Oak Medical Group Doing business as

National Provider Directory

National Provider Directory

Locations

1426 Canyon Ave NE
Unit B
Live Oak, FL 32064
Phone (386) 208-0537

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519344000000",
    "number": "1669568499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1426 CANYON AVE NE",
            "address_2": "UNIT B",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320644832",
            "telephone_number": "386-208-0537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1426 CANYON AVE NE",
            "address_2": "UNIT B",
            "city": "LIVE OAK",
            "state": "FL",
            "postal_code": "320644832",
            "telephone_number": "386-208-0537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE OAK HMA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2018-02-23",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "DIRECTOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "615-925-4565"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": "4314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660120100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "CE9137",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660120101",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shands Live Oak Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Live Oak, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2018; 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.