MEDICARE: JAY LUKE LUCAS M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	9934	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02-0654505	OTHER	SC	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10-00541	OTHER	RI	CAROLINA CARE PLAN

General Provider Information

NPI Number	:	1467404301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY LUKE LUCAS M.D.

Provider Business Mailing Address
First Line	:	1540 AMERICAN DRIVE
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29505
Country	:	US
Telephone Number	:	843-317-9999
Fax Number	:	843-317-1996

Provider Business Practice Location Address
First Line	:	1540 AMERICAN DR
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29505-6072
Country	:	US
Telephone Number	:	843-317-9999
Fax Number	:	843-317-1996

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	01/22/2020

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