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NPI Code Detail

MEDICARE: MS. MATTIE G LUSCO

MEDICARE: MS. MATTIE G LUSCO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235412206
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MATTIE G LUSCO
Provider Business Mailing Address
First Line : 623 BEECHWOOD ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32206-6236
Country : US
Telephone Number : 904-358-1211
Fax Number :
Provider Business Practice Location Address
First Line : 623 BEECHWOOD ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32206-6236
Country : US
Telephone Number : 904-358-1211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2011
Last Update Date : 12/16/2011

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Directions to “ MS. MATTIE G LUSCO ” Practice Location

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