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NPI Code Detail

MEDICARE: MR. JEFFREY H LACOURSE DO

MEDICARE: MR. JEFFREY H LACOURSE 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
1207R00000XInternal Medicine Physician215918NY
2207R00000XInternal Medicine Physician2006-01936NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578565032
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY H LACOURSE DO
Provider Business Mailing Address
First Line : PO BOX 601643
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-1643
Country : US
Telephone Number : 980-487-3678
Fax Number : 980-487-3294
Provider Business Practice Location Address
First Line : 201 E GROVER ST
Second Line :
City : SHELBY
State : NC
Zip : 28150-3917
Country : US
Telephone Number : 980-487-3678
Fax Number : 980-487-3294
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 01/23/2015

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Directions to “ MR. JEFFREY H LACOURSE DO” Practice Location

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