Provider Demographics
NPI:1073718227
Name:DANVILLE OSTEOPATHIC INTERNIST P.S.C.
Entity Type:Organization
Organization Name:DANVILLE OSTEOPATHIC INTERNIST P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:F
Authorized Official - Last Name:LACKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MS, PT
Authorized Official - Phone:859-238-9310
Mailing Address - Street 1:101 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1801
Mailing Address - Country:US
Mailing Address - Phone:859-238-9310
Mailing Address - Fax:859-238-9312
Practice Address - Street 1:101 S 2ND ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1801
Practice Address - Country:US
Practice Address - Phone:859-238-9310
Practice Address - Fax:859-238-9312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64034796Medicaid
KY0678001Medicare ID - Type Unspecified
KY64034796Medicaid