Provider Demographics
NPI:1780847202
Name:ANDRA G LANCE
Entity Type:Organization
Organization Name:ANDRA G LANCE
Other - Org Name:LANCE FAMILY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
Mailing Address - Fax:
Practice Address - Street 1:212 PEARL ST
Practice Address - Street 2:SUITE E
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1795
Practice Address - Country:US
Practice Address - Phone:740-286-1822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAN9377481Medicare PIN