Healthcare Provider Details

I. General information

NPI: 1285869255
Provider Name (Legal Business Name): LGC BILLING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2294 HOLSTON ST
DELTONA FL
32738-7839
US

IV. Provider business mailing address

2294 HOLSTON ST
DELTONA FL
32738-7839
US

V. Phone/Fax

Practice location:
  • Phone: 386-259-4011
  • Fax: 386-259-4808
Mailing address:
  • Phone: 386-259-4011
  • Fax: 386-259-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number10131
License Number StateFL

VIII. Authorized Official

Name: MRS. RUTH A CLAVERIA
Title or Position: PRESIDENT
Credential:
Phone: 386-259-4011