=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104343011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYONS CHVALA NEPHROLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2017
-----------------------------------------------------
Last Update Date | 08/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 N FRANKLIN ST STE 3
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19380-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-696-4956
-----------------------------------------------------
Fax | 610-696-5263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 N FRANKLIN ST STE 3
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19380-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-696-4956
-----------------------------------------------------
Fax | 610-696-5263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. PATRICIA J LYONS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 856-384-0238
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------