Healthcare Provider Details

I. General information

NPI: 1265408983
Provider Name (Legal Business Name): VANCE R LASSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23020 M RD
HOLTON KS
66436-8641
US

IV. Provider business mailing address

23020 M RD
HOLTON KS
66436-8641
US

V. Phone/Fax

Practice location:
  • Phone: 785-362-8677
  • Fax: 785-362-4372
Mailing address:
  • Phone: 785-362-8677
  • Fax: 785-362-4372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6104
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0431904
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: