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General NPI Number Information
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NPI Number | 1588982870
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Entity Type | Organization
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Legal Business Name | HUGH L LACEY MD PC
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 1905 W32ND STREET SUITE 306
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City | JOPLIN
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State | MO
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Zip | 64804-1512
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Country | US
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Telephone | 417-624-2111
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Fax | 417-624-1551
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Provider Business Mailing Address
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Address Line | PO BOX 2067
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City | JOPLIN
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State | MO
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Zip | 64804-2067
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Country | US
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Telephone | 417-624-2111
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Fax | 417-624-1551
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HUGH LAKE LACEY
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Credential | M.D.
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Telephone | 417-624-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | R6N85
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License Number State | MO
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