1841250982 NPI number — KATHLEEN E. LUCAS MD, PA

Table of content: (NPI 1841250982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841250982 NPI number — KATHLEEN E. LUCAS MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHLEEN E. LUCAS MD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841250982
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1416 YANCEYVILLE ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405-6955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-510-5510
Provider Business Mailing Address Fax Number:
336-510-5515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1416 YANCEYVILLE ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27405-6955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-510-5510
Provider Business Practice Location Address Fax Number:
336-510-5515
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUCAS
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-510-5510

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  31329 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 790238L , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: B9751 . This is a "MEDCOST INSURANCE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1200895 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1207825 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7560128 . This is a "AETNA INSURANCE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 87515 . This is a "MEDCOST INSURANCE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2468828 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 013VV . This is a "BLUE CROSS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7500692 . This is a "AETNA INSURANCE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: E0113 . This is a "MEDCOST INSURANCE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4238847 . This is a "AETNA INSURANCE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5900891 . This is a "AETNA INSURANCE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1201591 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 34585 . This is a "MEDCOST INSURANCE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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