MEDICARE: DR. EDDY LUCAS M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician	0427571	KS
2	2085B0100X	Body Imaging Physician	0427571	KS
3	2085R0202X	Diagnostic Radiology Physician	0427571	KS
4	2085P0229X	Pediatric Radiology Physician	0427571	KS
5	2085R0203X	Therapeutic Radiology Physician	0427571	KS
6	2085N0700X	Neuroradiology Physician	0427571	KS
7	2085U0001X	Diagnostic Ultrasound Physician	0427571	KS

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00628030	OTHER	KS	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1205832698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDDY LUCAS M.D.

Provider Business Mailing Address
First Line	:	3600 E HARRY ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-3713
Country	:	US
Telephone Number	:	316-689-5050
Fax Number	:	316-689-6192

Provider Business Practice Location Address
First Line	:	3600 E HARRY ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-3713
Country	:	US
Telephone Number	:	913-642-4900
Fax Number	:	913-381-0979

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	10/31/2011