Provider Demographics
NPI:1205007986
Name:JOHN W. LACE, M.D., INC.
Entity Type:Organization
Organization Name:JOHN W. LACE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPEAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-477-7782
Mailing Address - Street 1:140 LITTON DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5077
Mailing Address - Country:US
Mailing Address - Phone:530-477-7782
Mailing Address - Fax:530-477-7792
Practice Address - Street 1:140 LITTON DR
Practice Address - Street 2:SUITE 120
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5077
Practice Address - Country:US
Practice Address - Phone:530-477-7782
Practice Address - Fax:530-477-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G854760Medicaid
CAF31815OtherUPIN
CAZZZ30358ZMedicare PIN