VAN L LACKEY


Address: 1227 N State St, Ste 101, Jackson, MS 39202-2002
Phone: 6013552485

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
LA 1541575 05
MS 00115429 05
AETNA HEALTHCARE 4285654 01

Office Location

Street Address 1227 N STATE ST
STE 101
City JACKSON
State MS
Zip Code 39202-2002

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 207RX0202X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Medical Oncology

Taxonomy Definition

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]

Providers in the same taxonomy and city

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

Competitor

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City JACKSON
Zip Code 39202

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Dataset Information

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.

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