Provider Demographics
NPI:1770629487
Name:LANCE FAMILY MEDICINE
Entity Type:Organization
Organization Name:LANCE FAMILY MEDICINE
Other - Org Name:DAROLD LANCE DO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-286-1822
Mailing Address - Street 1:PO BOX 984
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-0984
Mailing Address - Country:US
Mailing Address - Phone:740-286-1822
Mailing Address - Fax:740-286-5852
Practice Address - Street 1:212 PEARL STREET SUITE E
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640
Practice Address - Country:US
Practice Address - Phone:740-286-1822
Practice Address - Fax:740-286-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty