MEDICARE: MORGAN ASHLEY LACEY

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
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1275963704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN ASHLEY LACEY

Provider Business Mailing Address
First Line	:	3262 SW ESPERANTO ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4622
Country	:	US
Telephone Number	:	954-461-1987
Fax Number	:	772-675-9100

Provider Business Practice Location Address
First Line	:	3262 SW ESPERANTO ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4622
Country	:	US
Telephone Number	:	954-461-1987
Fax Number	:	772-675-9100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	11/20/2013

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Directions to “ MORGAN ASHLEY LACEY ” Practice Location

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