Lackey, Van L
Lackey, Van L is an individual health care provider with primary practice located at 1227 N State St Ste 101, Jackson MS 39202-2002. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hematology & Oncology, Allopathic & Osteopathic Physicians / Medical Oncology. Allopathic & Osteopathic Physicians / Medical Oncology is his primary health care specialty. Lackey, Van L can be contacted via phone (601) 355-2485.Contact Information
Primary practice address
1227 N State St Ste 101
Jackson MS 39202-2002
Phone: (601) 355-2485
Fax: (601) 353-1463
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hematology & Oncology | 207RH0003X | 06430 | Mississippi |
| Allopathic & Osteopathic Physicians / Medical Oncology | 207RX0202X | 06430 | Mississippi |
Profile Details
| NPI number | 1740284389 |
|---|---|
| LBN Legal business name | Lackey, Van L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 10th, 2005 |
| Last updated | Jun 18th, 2010 - about 14 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 | 1740284389 | NPPES |
| Other | 4285654 | AETNA HEALTHCARE | |
| MEDICAID | 00115429 | AETNA HEALTHCARE | |
| MEDICAID | 1541575 | AETNA HEALTHCARE |
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