Provider Demographics
NPI:1205185808
Name:THE LUCAS CENTER, PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:THE LUCAS CENTER, PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER/OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-218-6210
Mailing Address - Street 1:10810 PARKSIDE DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934
Mailing Address - Country:US
Mailing Address - Phone:865-218-6210
Mailing Address - Fax:865-218-6211
Practice Address - Street 1:10810 PARKSIDE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934
Practice Address - Country:US
Practice Address - Phone:865-218-6210
Practice Address - Fax:865-218-6211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3879545Medicaid
TN3879545Medicaid