1679816813 NPI number — RACHEL CREA LUCAS D.O.

Table of content: RACHEL CREA LUCAS D.O. (NPI 1679816813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679816813 NPI number — RACHEL CREA LUCAS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCAS
Provider First Name:
RACHEL
Provider Middle Name:
CREA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1679816813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 CASSIDY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40502-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-412-5669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4855 N. MOORLAND ROAD
Provider Second Line Business Practice Location Address:
URGENT CARE CLINIC
Provider Business Practice Location Address City Name:
NEW BERLIN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53151-7494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-432-7599
Provider Business Practice Location Address Fax Number:
262-432-7694
Provider Enumeration Date:
04/05/2013

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: 2080H0002X , with the licence number:  05259 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 63288-21 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1679816813 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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