| Charles L. Lackey Md, Pc | |
|
1515 North Porter Ave Suite 200 Norman OK 73071-6446 | |
| (405) 366-8619 | |
| (405) 366-1839 |
| Full Name | Charles L. Lackey Md, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1515 North Porter Ave, Norman, Oklahoma |
| Authorized Official Name and Position | Charles Lackey (OWNER) |
| Authorized Official Contact | 4053668619 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles L. Lackey Md, Pc 1515 North Porter Ave Suite 200 Norman OK 73071-6446 Ph: (405) 366-8619 | Charles L. Lackey Md, Pc 1515 North Porter Ave Suite 200 Norman OK 73071-6446 Ph: (405) 366-8619 |
| NPI Number | 1144235995 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 08/31/2011 |
| Medicare PECOS PAC ID | 1456416890 |
|---|---|
| Medicare Enrollment ID | O20090218000212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144235995 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 12222 (Oklahoma) | Primary |
| Provider Name | Charles L Lackey |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1285625640 PECOS PAC ID: 2163459769 Enrollment ID: I20090217000135 |
| Provider Name | Amber Lynn Crosby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740556562 PECOS PAC ID: 6608028469 Enrollment ID: I20121201000020 |
| Provider Name | Blair Austin Kirkpatrick |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1942680087 PECOS PAC ID: 2365839610 Enrollment ID: I20220505000306 |
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