MEDICARE: MEGHAN LANE JEZ PA-C

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	363AM0700X	Medical Physician Assistant	003163	OH

General Provider Information

NPI Number	:	1780985895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN LANE JEZ PA-C

Provider Business Mailing Address
First Line	:	2913 MADISON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-2017
Country	:	US
Telephone Number	:	513-305-5126
Fax Number	:

Provider Business Practice Location Address
First Line	:	7794 5 MILE RD STE 240
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2372
Country	:	US
Telephone Number	:	513-231-1575
Fax Number	:	855-818-3918

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	02/27/2023

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