Provider Demographics
NPI:1124094388
Name:LACKEY, STEVEN KENNETH (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:KENNETH
Last Name:LACKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N JUSTICE ST # 16
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3410
Mailing Address - Country:US
Mailing Address - Phone:828-694-8350
Mailing Address - Fax:828-694-7654
Practice Address - Street 1:800 N JUSTICE ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3410
Practice Address - Country:US
Practice Address - Phone:828-674-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
03-0455058OtherHEALTHCARE SAVINGS
NC7950512Medicaid
N31855OtherSC MEDICAID
03-0455058OtherCIGNA HEALTHCARE
50512OtherBCBS NC
NCNCI531AOtherMEDICARE PTAN
01-70268OtherUNITED HEALTHCARE
43889OtherMEDCOST
03-0455058OtherCRESENT
080191010OtherRR MEDICARE
354567600OtherOWCP
NCP01413618OtherRR MEDICARE
NCNCI531AMedicare PIN