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General NPI Number Information
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NPI Number | 1568788909
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Entity Type | Organization
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Legal Business Name | LUCASVILLE MEDICAL SPECIALIST
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 04/09/2010
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Provider Practice Location Address
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Address Line | 10940 STATE ROUTE 104
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City | LUCASVILLE
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State | OH
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Zip | 45648-8495
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Country | US
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Telephone | 740-259-1416
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Fax | 740-259-2232
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Provider Business Mailing Address
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Address Line | 10940 STATE ROUTE 104
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City | LUCASVILLE
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State | OH
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Zip | 45648-8495
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Country | US
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Telephone | 740-259-1416
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Fax | 740-259-2232
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER STEGAWSKI
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Credential | MD
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Telephone | 740-259-1416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 1910294
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License Number State | OH
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