Provider Demographics
NPI:1508271792
Name:G.A.LUCAS ENTERPRISES, PS
Entity Type:Organization
Organization Name:G.A.LUCAS ENTERPRISES, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-202-6596
Mailing Address - Street 1:1817 E SPRINGFIELD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2913
Mailing Address - Country:US
Mailing Address - Phone:509-202-6596
Mailing Address - Fax:509-290-6566
Practice Address - Street 1:1817 E SPRINGFIELD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2913
Practice Address - Country:US
Practice Address - Phone:509-202-6596
Practice Address - Fax:509-290-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60203603261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service