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NPI Code Detail

MEDICARE: LISA G. MAYNARD

MEDICARE: LISA G. MAYNARD
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
1332BX2000XOxygen Equipment & Supplies (DME)0206009194VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790950251
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA G. MAYNARD
Provider Business Mailing Address
First Line : 376 W MAIN ST
Second Line :
City : COVINGTON
State : VA
Zip : 24426-1517
Country : US
Telephone Number : 540-962-4433
Fax Number :
Provider Business Practice Location Address
First Line : 376 W MAIN ST
Second Line :
City : COVINGTON
State : VA
Zip : 24426-1517
Country : US
Telephone Number : 540-962-4433
Fax Number : 540-962-4434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2008
Last Update Date : 06/28/2008

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