Provider Demographics
NPI:1528204385
Name:LACY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LACY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:ONGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-281-2178
Mailing Address - Street 1:405 SLIDE RD
Mailing Address - Street 2:STE 111-115
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 SLIDE RD
Practice Address - Street 2:STE 111-115
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4356
Practice Address - Country:US
Practice Address - Phone:806-281-2178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty