MEDICARE: LISA M HUGHES 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
1	363A00000X	Physician Assistant	50000497	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970022370	OTHER	OH	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1417997313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M HUGHES PA-C

Provider Business Mailing Address
First Line	:	3300 BAILEY ST NW
Second Line	:	SUITE 104
City	:	MASSILLON
State	:	OH
Zip	:	44646-3613
Country	:	US
Telephone Number	:	330-837-3823
Fax Number	:	330-837-8313

Provider Business Practice Location Address
First Line	:	3300 BAILEY ST NW
Second Line	:	SUITE 104
City	:	MASSILLON
State	:	OH
Zip	:	44646-3613
Country	:	US
Telephone Number	:	330-837-3823
Fax Number	:	330-837-8313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	12/12/2014

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