Charles L. Lackey Md, Pc | |
1515 North Porter Ave Suite 200 Norman OK 73071-6446 | |
(405) 366-8619 | |
(405) 366-1839 |
Full Name | Charles L. Lackey Md, Pc |
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Speciality | Internal Medicine |
Location | 1515 North Porter Ave, Norman, Oklahoma |
Authorized Official Name and Position | Charles Lackey (OWNER) |
Authorized Official Contact | 4053668619 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Charles L. Lackey Md, Pc 1515 North Porter Ave Suite 200 Norman OK 73071-6446 Ph: (405) 366-8619 | Charles L. Lackey Md, Pc 1515 North Porter Ave Suite 200 Norman OK 73071-6446 Ph: (405) 366-8619 |
NPI Number | 1144235995 |
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Provider Enumeration Date | 07/30/2006 |
Last Update Date | 08/31/2011 |
Medicare PECOS PAC ID | 1456416890 |
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Medicare Enrollment ID | O20090218000212 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144235995 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | 12222 (Oklahoma) | Primary |
Provider Name | Blair Austin Kirkpatrick |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1942680087 PECOS PAC ID: 2365839610 Enrollment ID: I20220505000306 |
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