| Jeffrey L Lackore, PA | |
|
6120 Sandhurst Dr, Roanoke, VA 24018-7798 | |
| (712) 253-6104 | |
| Not Available |
| Full Name | Jeffrey L Lackore |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 6120 Sandhurst Dr, Roanoke, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306879192 | NPI | - | NPPES |
| 1306879192 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 0110001943 (Virginia) | Primary |
| 363A00000X | Physician Assistant | PA20332 (California) | Secondary |
| Entity Name | Sonoma Valley Emergency Physicians Medical Group, Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1710164629 PECOS PAC ID: 1355420191 Enrollment ID: O20080506000390 |
| Entity Name | Woodland Emergency Physicians Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1881868164 PECOS PAC ID: 8921176785 Enrollment ID: O20081007000014 |
| Entity Name | Vallejo Emergency Physicians Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083916373 PECOS PAC ID: 2961683693 Enrollment ID: O20110228000897 |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey L Lackore, PA 6120 Sandhurst Dr, Roanoke, VA 24018-7798 Ph: Not Available | Jeffrey L Lackore, PA 6120 Sandhurst Dr, Roanoke, VA 24018-7798 Ph: (712) 253-6104 |
Sarah Alyse Guzinski-homcha, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2001 Crystal Spring Ave Sw Ste 201, Roanoke, VA 24014 Phone: 540-853-0100 |
Ms. Kathryn Conrad Hoyt, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2331 Franklin Rd Sw, Roanoke, VA 24014 Phone: 540-725-1226 Fax: 540-857-5306 |
Allison Elisabeth Basiley, Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 101 Elm Ave Se, Roanoke, VA 24013 Phone: 540-831-1684 |
Mr. Jason Andrew Peery, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2331 Franklin Rd Sw, Roanoke, VA 24014 Phone: 540-510-6200 Fax: 540-857-5306 |
Nicole Maalouf Shively, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1622 Westover Ave Sw, Roanoke, VA 24015 Phone: 339-368-1887 |
Jared Waters, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 5673 Airport Rd, Roanoke, VA 24012 Phone: 540-523-8080 |
Mrs. Melissa L Swihart, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 4035 Electric Rd Ste A, Roanoke, VA 24018 Phone: 540-772-8670 Fax: 540-772-7901 |