Provider Demographics
NPI:1316166028
Name:LUCAS SURGICAL GROUP PA
Entity type:Organization
Organization Name:LUCAS SURGICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-453-4641
Mailing Address - Street 1:PO DRAWER 1974
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-1974
Mailing Address - Country:US
Mailing Address - Phone:662-453-4641
Mailing Address - Fax:662-455-4731
Practice Address - Street 1:501 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930
Practice Address - Country:US
Practice Address - Phone:662-453-4641
Practice Address - Fax:662-455-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00851891Medicaid
MSC00585Medicare Oscar/Certification