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NPI Code Detail

MEDICARE: MISS LACEY C GREGO PA-C

MEDICARE: MISS LACEY C GREGO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant50.005995RXOH

General Provider Information

NPI Number : 1144641382
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LACEY C GREGO PA-C
Provider Business Mailing Address
First Line : 1082 FRESNO DR
Second Line :
City : WESTLAKE
State : OH
Zip : 44145-2728
Country : US
Telephone Number : 254-290-8535
Fax Number :
Provider Business Practice Location Address
First Line : 9500 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44195-0001
Country : US
Telephone Number : 216-347-9885
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2013
Last Update Date : 12/08/2024

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Directions to “ MISS LACEY C GREGO PA-C” Practice Location

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