Provider Demographics
NPI:1851409403
Name:LUCAS, PAULA JO (PAC)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JO
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:PAULA
Other - Middle Name:JO
Other - Last Name:SLIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:380 SUMMIT AVENUE
Mailing Address - Street 2:MSO PHYSICIAN BILLING
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7597
Mailing Address - Fax:740-283-7190
Practice Address - Street 1:3151 JOHNSON RD STE 2
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2362
Practice Address - Country:US
Practice Address - Phone:740-266-3866
Practice Address - Fax:740-266-3865
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01004363A00000X
1055291363A00000X
OH50001925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094129Medicaid
PA77341OtherPIN