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General NPI Number Information
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NPI Number | 1407081177
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Entity Type | Organization
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Legal Business Name | LACY MEDICAL GROUP INC
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Dates
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Enumeration Date | 05/23/2009
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Last Update Date | 05/23/2009
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Provider Practice Location Address
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Address Line | 393 VANADIUM RD
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City | PITTSBURGH
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State | PA
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Zip | 15243-1427
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Country | US
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Telephone | 412-805-3812
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Fax |
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Provider Business Mailing Address
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Address Line | 393 VANADIUM RD
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City | PITTSBURGH
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State | PA
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Zip | 15243-1427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL T TROMBLEY
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Credential |
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Telephone | 412-805-3812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD427067
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License Number State | PA
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