Healthcare Provider Details

I. General information

NPI: 1932899176
Provider Name (Legal Business Name): LUCAS FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 N 12TH ST
MIDDLESBORO KY
40965-1133
US

IV. Provider business mailing address

403 SHARPES WOODS RD
PINEVILLE KY
40977-7539
US

V. Phone/Fax

Practice location:
  • Phone: 423-444-3368
  • Fax:
Mailing address:
  • Phone: 423-444-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHON EDWARD LUCAS
Title or Position: CO-OWNER/ MANAGER
Credential:
Phone: 423-444-3368