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NPI Code Detail

MEDICARE: LAUREN PAUNICKA SOUTHWOOD P.A.

MEDICARE: LAUREN PAUNICKA SOUTHWOOD P.A.
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
1363A00000XPhysician Assistant50.003600OH

General Provider Information

NPI Number : 1538419643
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN PAUNICKA SOUTHWOOD P.A.
Provider Business Mailing Address
First Line : 560 S LOOP RD
Second Line :
City : EDGEWOOD
State : KY
Zip : 41017-3405
Country : US
Telephone Number : 859-301-2663
Fax Number : 859-817-7848
Provider Business Practice Location Address
First Line : 6620 CLOUGH PIKE
Second Line :
City : CINCINNATI
State : OH
Zip : 45244-4053
Country : US
Telephone Number : 513-232-2663
Fax Number : 859-817-7848
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2012
Last Update Date : 05/25/2021

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Directions to “ LAUREN PAUNICKA SOUTHWOOD P.A.” Practice Location

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