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JOHN LACKEY MD NPI 1063456648


NPI Information

NPI: 1063456648
Provider Name: JOHN LACKEY, MD
Classification: Specialist - 174400000X
Entity Type: Individual
Organization: NOT TSOO GAH NEE INDIAN HEALTH

PECOS Registration: Yes

Address:
500 S 11TH AVE
POCATELLO, ID
ZIP 83201
Phone: (208) 232-3103
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John Lackey, MD is a specialist in Pocatello, ID with 56 years of experience. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. John Lackey, MD NPI is 1063456648. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF MISSOURI, KANSAS CITY, SCHOOL OF MEDICINE
Graduation Year:1968

The provider's business location address is:

500 S 11TH AVE
POCATELLO, ID
ZIP 83201-835
Phone: (208) 232-3103
Fax: (208) 232-0756

The NPI 1063456648 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Insertion of needle into vein for collection of blood sample (HCPCS:36415)
  • Automated urinalysis test (HCPCS:81003)
  • Complete blood cell count (red cells, white blood cell, platelets), automated test (HCPCS:85025)
  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Administration of pneumococcal vaccine (HCPCS:G0009)
  • X-ray of chest, 2 views, front and side (HCPCS:71020)

The enumeration date for this NPI number is 6/15/2006 and was last updated on 7/8/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistM3873IDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11112742MEDICARE ID-TYPE UNSPECIFIEDIDAHO
2C36869MEDICARE UPINIDAHO
3002487500MEDICAIDIDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.