Provider Demographics
NPI:1427163724
Name:MCCLAIN, LACY C (MD)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:C
Last Name:MCCLAIN
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 1:1011 S 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3002
Mailing Address - Country:US
Mailing Address - Phone:601-261-5163
Mailing Address - Fax:
Practice Address - Street 1:1011 S 34TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3002
Practice Address - Country:US
Practice Address - Phone:601-261-5163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17269208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124167Medicaid
MS1559343OtherAMERICAN ADMIN GROUP
MS780001988OtherRAILROAD MEDICARE
MS00124167Medicaid
MS780000060Medicare PIN