Provider Demographics
NPI:1215156062
Name:HAMILTON-LUCAS PHYSICIANS PA
Entity type:Organization
Organization Name:HAMILTON-LUCAS PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-709-1961
Mailing Address - Street 1:1801 N HAMPTON RD
Mailing Address - Street 2:STE 315
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2391
Mailing Address - Country:US
Mailing Address - Phone:972-709-1961
Mailing Address - Fax:972-283-1681
Practice Address - Street 1:1801 N HAMPTON RD
Practice Address - Street 2:STE 315
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2391
Practice Address - Country:US
Practice Address - Phone:972-709-1961
Practice Address - Fax:972-283-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH74592084P0800X
TXG74072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86X590OtherBLUE CROSS DR. LUCAS
TX084786501Medicaid
TX86X591OtherBLUE CROSS DR HAMILTON
TX86X591OtherBLUE CROSS DR HAMILTON
TX86X590OtherBLUE CROSS DR. LUCAS
TX86X591OtherBLUE CROSS DR HAMILTON
TXB98838Medicare UPIN
TX00R44ZMedicare ID - Type UnspecifiedMEDICARE GROUP #