Provider Demographics
NPI:1114104197
Name:DR. LACEY J LOVELAND DPM PC
Entity Type:Organization
Organization Name:DR. LACEY J LOVELAND DPM PC
Other - Org Name:OREGON FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:541-344-5144
Mailing Address - Street 1:755 EAST 11TH AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3313
Mailing Address - Country:US
Mailing Address - Phone:541-344-5144
Mailing Address - Fax:541-344-5504
Practice Address - Street 1:755 EAST 11TH AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3313
Practice Address - Country:US
Practice Address - Phone:541-344-5144
Practice Address - Fax:541-344-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2009-06-13
Deactivation Date:2008-11-17
Deactivation Code:
Reactivation Date:2009-05-08
Provider Licenses
StateLicense IDTaxonomies
ORDP00433213E00000X
OR6148720002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6148720002Medicare NSC
ORR140272Medicare PIN