Lackey, John
Lackey, John is an individual health care provider with primary practice located at 500 S 11Th Ave , Pocatello ID 83201-4835. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Lackey, John can be contacted via phone (208) 232-3103.Contact Information
Primary practice address
500 S 11Th Ave
Pocatello ID 83201-4835
Phone: (208) 232-3103
Fax: (208) 232-0756
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | M3873 | Idaho |
Profile Details
| NPI number | 1063456648 |
|---|---|
| LBN Legal business name | Lackey, John |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 15th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063456648 | NPPES |
| Idaho | MEDICAID | 002487500 |
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