Provider Demographics
NPI:1407228588
Name:LYONS PRIMARY URGENT CARE LLC
Entity Type:Organization
Organization Name:LYONS PRIMARY URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER APRN CNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALBERTA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:ESPINOZA-LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:740-343-0450
Mailing Address - Street 1:322 W WATER ST
Mailing Address - Street 2:P.O.BOX 635
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-1479
Mailing Address - Country:US
Mailing Address - Phone:740-343-0450
Mailing Address - Fax:
Practice Address - Street 1:322 W WATER ST
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1479
Practice Address - Country:US
Practice Address - Phone:740-343-0450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.260365 COA10303NP261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0166257Medicaid
OHH357940Medicare UPIN