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DR. ANDREA JUNE LACK M.D. NPI 1699060905


NPI Information

NPI: 1699060905
Provider Name: DR. ANDREA JUNE LACK, M.D.
Classification: Pediatrics - 208000000X
Entity Type: Individual
Organization: LEGACY COMMUNITY HEALTH SERVICES, INC

PECOS Registration: Yes

Address:
6550 MAPLERIDGE ST
SUITE 106
HOUSTON, TX
ZIP 77081
Phone: (832) 548-5000
Get Directions

DR. Andrea June Lack, M.D. is a pediatrics in Houston, TX with 13 years of experience. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. DR. Andrea June Lack, M.D. NPI is 1699060905. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
Graduation Year:2011

The provider's business location address is:

6550 MAPLERIDGE ST
SUITE 106
HOUSTON, TX
ZIP 77081-600
Phone: (832) 548-5000

The NPI 1699060905 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 enumeration date for this NPI number is 6/14/2011 and was last updated on 10/9/2019.


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
1207R00000XInternal MedicineQ5461TEXASNo
2208000000XPediatricsQ5461TEXASYes

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
1BP10041723OTHERTEXASTEXAS MEDICAL BOARD PHYSICIAN IN TRAINING PERMIT
2Q5461OTHERTEXASTX MEDICAL BOARD LICENSE EFF 8/3/15
31679524961OTHERTEXASLEGACY COMMUNITY HEALTH SERVICES INC MEDICAID #
4741819OTHERTEXASLEGACY SITE SPECIFIC MEDICARE #

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.