1033312376 NPI number — MISS LISA GAY LANCASTER

Table of content: MISS LISA GAY LANCASTER (NPI 1033312376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033312376 NPI number — MISS LISA GAY LANCASTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANCASTER
Provider First Name:
LISA
Provider Middle Name:
GAY
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033312376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 342
Provider Second Line Business Mailing Address:
166 RICHARDS RD
Provider Business Mailing Address City Name:
MINFORD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-820-3957
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8065 BELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEELERSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-574-2401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2631405 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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