Healthcare Provider Details

I. General information

NPI: 1942738372
Provider Name (Legal Business Name): LACEY GIAMBELLUCA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 N ACADIA RD STE 1000
THIBODAUX LA
70301-5051
US

IV. Provider business mailing address

PO BOX 28
THIBODAUX LA
70302-0028
US

V. Phone/Fax

Practice location:
  • Phone: 985-625-2200
  • Fax: 985-625-2206
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number336108
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number336108
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: