Provider Demographics
NPI:1669247037
Name:LACEY GIAMBELLUCA MD, LLC
Entity type:Organization
Organization Name:LACEY GIAMBELLUCA MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAMBELLUCA
Authorized Official - Suffix:
Authorized Official - Credentials:GRETTA BOURGEOIS
Authorized Official - Phone:985-313-1015
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-0028
Mailing Address - Country:US
Mailing Address - Phone:985-625-2200
Mailing Address - Fax:
Practice Address - Street 1:726 N ACADIA RD STE 1000
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5051
Practice Address - Country:US
Practice Address - Phone:985-625-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty