Dr Stuart R Lacey, MD | |
5310 W Thunderbird Rd, Suite110, Glendale, AZ 85306-4706 | |
(602) 865-4065 | |
(602) 865-6100 |
Full Name | Dr Stuart R Lacey |
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Gender | Male |
Speciality | Surgery - Pediatric Surgery |
Location | 5310 W Thunderbird Rd, Glendale, Arizona |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1831171107 | NPI | - | NPPES |
788763 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2086S0120X | Surgery - Pediatric Surgery | 31590 (Arizona) | Primary |
2086S0120X | Surgery - Pediatric Surgery | MD155068 (Oregon) | Secondary |
Entity Name | Banner Physician Super Specialists Arizona Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1841573870 PECOS PAC ID: 7911173794 Enrollment ID: O20111228000353 |
Mailing Address | Practice Location Address |
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Dr Stuart R Lacey, MD 5310 W Thunderbird Rd, Suite110, Glendale, AZ 85306-4706 Ph: (602) 865-4065 | Dr Stuart R Lacey, MD 5310 W Thunderbird Rd, Suite110, Glendale, AZ 85306-4706 Ph: (602) 865-4065 |
Joseph S Janik, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 5310 W Thunderbird Rd, Suite 110, Glendale, AZ 85306 Phone: 602-865-4065 Fax: 602-865-6100 | |
Layne C. Sandridge, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 18700 N 64th Dr Ste 105a, Glendale, AZ 85308 Phone: 623-688-5075 Fax: 623-688-5075 | |
Sivakami Brenda Moorthy, DO Surgery Medicare: Accepting Medicare Assignments Practice Location: 5757 W Thunderbird Rd, E351, Glendale, AZ 85306 Phone: 602-374-3440 Fax: 602-374-3441 | |
Dr. Lannery Sioeli Lauvao, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 18555 N 79th Ave Ste B101, Glendale, AZ 85308 Phone: 623-512-4326 Fax: 623-594-2252 | |
Dr. Emily Welker, M.D. Surgery Medicare: Medicare Enrolled Practice Location: 5810 W Beverly Ln, Glendale, AZ 85306 Phone: 623-312-3000 Fax: 623-312-3060 | |
Karthik Raghavan, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 5700 W Olive Ave Ste 106, Glendale, AZ 85302 Phone: 623-377-7011 Fax: 623-344-8353 | |
Ronald L. Bauer, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 6320 W Union Hills Dr Ste 1600b, Glendale, AZ 85308 Phone: 602-277-4868 Fax: 602-230-9350 |