1780623942 NPI number — JULIE ROSE LUCAS PA-C

Table of content: JULIE ROSE LUCAS PA-C (NPI 1780623942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780623942 NPI number — JULIE ROSE LUCAS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCAS
Provider First Name:
JULIE
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EDMOND
Provider Other First Name:
JULIE
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780623942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40480
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36640-0480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-660-5787
Provider Business Mailing Address Fax Number:
251-660-5740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 S UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
UCOM 6000 A
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36688-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-660-5787
Provider Business Practice Location Address Fax Number:
251-660-5540
Provider Enumeration Date:
06/05/2006

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: 363A00000X , with the licence number:  PA-217 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009930270 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0124863 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51098015 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51098018 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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