Provider Demographics
NPI:1932899176
Name:LUCAS FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:LUCAS FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-444-3368
Mailing Address - Street 1:403 SHARPES WOODS RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-7539
Mailing Address - Country:US
Mailing Address - Phone:423-444-3368
Mailing Address - Fax:
Practice Address - Street 1:473 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1133
Practice Address - Country:US
Practice Address - Phone:423-444-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty