Provider Demographics
NPI:1588982870
Name:HUGH L LACEY MD PC
Entity type:Organization
Organization Name:HUGH L LACEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:LAKE
Authorized Official - Last Name:LACEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-624-2111
Mailing Address - Street 1:PO BOX 2067
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2067
Mailing Address - Country:US
Mailing Address - Phone:417-624-2111
Mailing Address - Fax:417-624-1551
Practice Address - Street 1:1905 W32ND STREET
Practice Address - Street 2:SUITE 306
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1512
Practice Address - Country:US
Practice Address - Phone:417-624-2111
Practice Address - Fax:417-624-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6N85207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1760565048OtherINDIVIDUAL NPI