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General NPI Number Information
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NPI Number | 1396249785
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Entity Type | Organization
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Legal Business Name | LCA LOWELL
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1 COURTHOUSE LN UNIT 7
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City | CHELMSFORD
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State | MA
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Zip | 01824-1735
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Country | US
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Telephone | 978-649-7577
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Fax |
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Provider Business Mailing Address
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Address Line | 1 COURTHOUSE LN UNIT 7
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City | CHELMSFORD
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State | MA
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Zip | 01824-1735
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Country | US
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Telephone | 978-649-7577
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LYNN GERVAIS SMITH
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Credential | ETC
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Telephone | 978-649-7577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State | MA
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