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General NPI Number Information
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NPI Number | 1720060247
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Entity Type | Individual
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Provider Name | DR. THOMAS KEVIN LACKEY
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Gender | Male
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 3804 RAINBOW DR
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City | RAINBOW CITY
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State | AL
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Zip | 35906
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Country | US
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Telephone | 256-952-2200
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Fax | 256-952-2202
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Provider Business Mailing Address
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Address Line | 3804 RAINBOW DR
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City | RAINBOW CITY
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State | AL
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Zip | 35906-3051
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Country | US
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Telephone | 256-952-2200
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Fax | 256-952-2202
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 21928
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License Number State | AL
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