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NPI Code Detail

MEDICARE: ELIZABETH A LACY DO

MEDICARE: ELIZABETH A LACY DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist200300169NC
2207P00000XEmergency Medicine Physician20A13779CA
3207P00000XEmergency Medicine PhysicianDR.0060926CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1135YNOTHERNCBSNC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134170772
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH A LACY DO
Provider Business Mailing Address
First Line : 400 W 16TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-2781
Country : US
Telephone Number : 171-958-4430
Fax Number : 719-595-7886
Provider Business Practice Location Address
First Line : 400 W 16TH ST
Second Line :
City : PUEBLO
State : CO
Zip : 81003-2781
Country : US
Telephone Number : 719-584-4306
Fax Number : 719-595-7886
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2006
Last Update Date : 11/07/2018

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Directions to “ ELIZABETH A LACY DO” Practice Location

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