Provider Demographics
NPI:1013196245
Name:PAGES FAMILY PRACTICE LTD
Entity Type:Organization
Organization Name:PAGES FAMILY PRACTICE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-352-2750
Mailing Address - Street 1:1157 N MONROE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-1697
Mailing Address - Country:US
Mailing Address - Phone:937-352-2750
Mailing Address - Fax:937-352-3751
Practice Address - Street 1:1157 N MONROE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1697
Practice Address - Country:US
Practice Address - Phone:937-352-2750
Practice Address - Fax:937-352-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068066P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0115726Medicaid
OH0115726Medicaid