Provider Demographics
NPI:1568788909
Name:LUCASVILLE MEDICAL SPECIALIST
Entity Type:Organization
Organization Name:LUCASVILLE MEDICAL SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEGAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-259-1416
Mailing Address - Street 1:10940 STATE ROUTE 104
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8495
Mailing Address - Country:US
Mailing Address - Phone:740-259-1416
Mailing Address - Fax:740-259-2232
Practice Address - Street 1:10940 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8495
Practice Address - Country:US
Practice Address - Phone:740-259-1416
Practice Address - Fax:740-259-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1910294207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty