Healthcare Provider Details

I. General information

NPI: 1205185808
Provider Name (Legal Business Name): THE LUCAS CENTER, PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 PARKSIDE DR SUITE 310
KNOXVILLE TN
37934
US

IV. Provider business mailing address

10810 PARKSIDE DR SUITE 310
KNOXVILLE TN
37934
US

V. Phone/Fax

Practice location:
  • Phone: 865-218-6210
  • Fax: 865-218-6211
Mailing address:
  • Phone: 865-218-6210
  • Fax: 865-218-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD0000036890
License Number StateTN

VIII. Authorized Official

Name: DR. JAY H LUCAS
Title or Position: CHIEF OFFICER/OWNER/PHYSICIAN
Credential: M.D.
Phone: 865-218-6210