Provider Demographics
NPI:1831244011
Name:LUCAS,PARKS,REA & VANDAALEN, PLC
Entity type:Organization
Organization Name:LUCAS,PARKS,REA & VANDAALEN, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCO
Authorized Official - Middle Name:R
Authorized Official - Last Name:REA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-366-8825
Mailing Address - Street 1:4402 CHURCHMAN AVE
Mailing Address - Street 2:STE, 205
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1190
Mailing Address - Country:US
Mailing Address - Phone:502-366-8825
Mailing Address - Fax:502-366-0044
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:STE, 205
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1190
Practice Address - Country:US
Practice Address - Phone:502-366-8825
Practice Address - Fax:502-366-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17917208G00000X
KY26040208G00000X
KY27240208G00000X
IN32579208G00000X
IN28268208G00000X
IN46343208G00000X
IN40712208G00000X
KY19706208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1048803OtherPASSPORT
KY65926958Medicaid
CN3171OtherRAILROAD MEDICARE
KY65926958Medicaid
KY1048803OtherPASSPORT
KY3565Medicare PIN
CN3171OtherRAILROAD MEDICARE