VAN L LACKEY (NPI# 1740284389) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1740284389 |
Entity Type | Individual |
Full Name | VAN L LACKEY |
Credential | M.D. |
Practice Address |
1227 N State St Ste 101 Jackson MS 39202-2002 |
Practice Telephone | 6013552485 |
Practice Fax Number | 6013531463 |
Mailing Telephone | 6013552485 |
Mailing Fax Number | 6013531463 |
Enumeration Date | 2005-06-10 |
Last Update Date | 2010-06-18 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
06430 | MS | Allopathic & Osteopathic Physicians |
Y | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
06430 | MS | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
LA | 1541575 | 05 | |
MS | 00115429 | 05 | |
AETNA HEALTHCARE | 4285654 | 01 |
Street Address |
1227 N STATE ST STE 101 |
City | JACKSON |
State | MS |
Zip Code | 39202-2002 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992958169 | Lori Beth Brent | Nurse Practitioner | 1227 N State St, Ste 101, Jackson, MS 39202-2002 | 2008-10-31 |
1295776136 | Jackson Oncology Associates | Internal Medicine | 1227 N State St, Ste 101, Jackson, MS 39202-2002 | 2006-06-10 |
1245212844 | Bobby S Wilkerson | Internal Medicine | 1227 N State St, Suite 101, Jackson, MS 39202-2002 | 2005-11-18 |
1013911668 | Tammy H Young | Internal Medicine | 1227 N State St, Ste 101, Jackson, MS 39202-2002 | 2005-06-10 |
1912901513 | Grace G Shumaker | Internal Medicine | 1227 N State St, Ste 101, Jackson, MS 39202-2002 | 2005-06-10 |
1821092479 | Anne P Berthold | Nurse Practitioner | 1227 N State St, Ste 101, Jackson, MS 39202-2002 | 2005-06-10 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
Find all providers in zip 39202 |
Taxonomy Code | 207RX0202X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Medical Oncology |
An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source. 11/5/2007: corrected definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457328692 | Dwight Kaufman | Internal Medicine | 720 W Forest Avenue, Jackson, TN 38301-3902 | 2006-03-07 |
1134666001 | W.a. Foote Memorial Hospital, Inc | Internal Medicine | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
1518178524 | Natale Tate Sheehan | Internal Medicine | 1227 N State St Ste 101, Jackson, MS 39202-2002 | 2007-05-24 |
1043380108 | Radiation Oncology Associates, PC | Internal Medicine | 322 Hospital Blvd, Jackson, TN 38305-2079 | 2006-11-08 |
1366478356 | Ralph B. Vance Iv | Internal Medicine | 2500 North State Street, Department of Medicine/division of Oncology, Jackson, MS 39216-4500 | 2006-06-23 |
1619913928 | Louis V Puneky | Internal Medicine | 2500 North State Street, Department of Medicine/division of Oncology, Jackson, MS 39216-4500 | 2006-06-22 |
1154367837 | Robert D. Hamilton | Internal Medicine | 2500 North State Street, Department of Medicine/division of Hematology, Jackson, MS 39216-4500 | 2006-06-21 |
1710921895 | James Tate Thigpen | Internal Medicine | 2500 North State Street, Department of Medicine/division of Oncology, Jackson, MS 39216-4500 | 2006-06-16 |
1356380851 | John Charles Ruckdeschel | Internal Medicine | 2500 N State St, Jackson, MS 39216-4500 | 2006-06-06 |
1992773428 | Eugene P Reese Jr. | Internal Medicine | 616 W Forest Ave, Jackson, TN 38301-3902 | 2006-03-10 |
Find all providers in JACKSON |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.