Healthcare Provider Details

I. General information

NPI: 1841744547
Provider Name (Legal Business Name): ERIC TRUSHAW PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N EWING ST
LANCASTER OH
43130-3372
US

IV. Provider business mailing address

87 N FRANKFORT ST
MINSTER OH
45865-1042
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-8000
  • Fax:
Mailing address:
  • Phone: 937-638-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004759RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: