Individual provider Active NPI

Thomas Britt Lackey, ENP

  • Family Nurse Practitioner
  • Lumberton, TX
National Provider Identifier
1205904174
Registry record updated Jan 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
641335 Issued in TX
Practice address
655 S Main St
Lumberton, TX 77657-7378
Phone
(409) 227-4084
Fax
(409) 227-4140
NPI assigned
Dec 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X TX
Family Nurse Practitioner 363LF0000X 641335 TX Primary

Addresses

Primary practice location

655 S Main St
Lumberton, TX 77657-7378

Mailing address

PO Box 7714
Beaumont, TX 77726-7714
Phone (409) 893-1177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040504000649 TX Practitioner - Nurse Practitioner 4688662117 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orange County Urgent Care PLLCGroup PAC ID 5193045839, 6 clinicians
Hardin County Urgent Care PLLCGroup PAC ID 1153736657, 5 clinicians

Practice addresses (Care Compare)

220 Strickland Dr
Orange, TX 77630-4750
Phone (409) 330-4707

655 S Main St
Lumberton, TX 77657-7378
Phone (409) 227-4084

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
641335TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Doctors Express of the Beaumont Area PA Urgent Care CurrentSince Apr 26, 2012 Accepting new patients
Hardin County Urgent Care PLLC Urgent Care CurrentSince Feb 21, 2021 Accepting new patients
Orange County Urgent Care PLLC Urgent Care CurrentSince Dec 4, 2014 Accepting new patients
Jefferson Emergency Medicine Associates PA Past Accepting new patients
Brazos Emergency Physicians, PA Past Accepting new patients
Pioneer Emergency Medicine Associates PA Past Accepting new patients
Southeast Emergency Physician Associates, P.a. Past Accepting new patients

Locations

3195 Dowlen Rd
Ste 105
Beaumont, TX 77706
Phone (409) 860-1888

6445 FM 1463 Rd
Ste 230
Katy, TX 77494
Phone (281) 990-6890

655 S Main St
Lumberton, TX 77657
Phone (409) 227-4084

1908 Highway 365
Nederland, TX 77627
Phone (409) 729-1900

220 Strickland Dr
Orange, TX 77630
Phone (409) 330-4707

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1205904174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7714",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777267714",
            "telephone_number": "409-893-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 S MAIN ST",
            "city": "LUMBERTON",
            "state": "TX",
            "postal_code": "776577378",
            "telephone_number": "409-227-4084",
            "fax_number": "409-227-4140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "THOMAS",
        "middle_name": "BRITT",
        "name_prefix": "Mr.",
        "credential": "ENP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "641335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lumberton, TX

Sources for this page

Verify at the official NPI Registry.