Active NPI
Ian David Lackey, ATC
- Athletic Trainer
- Vermillion, SD
National Provider Identifier
1609325539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0460
- Practice address
- 414 E Clark St
Vermillion, SD 57069-2307 - Phone
- (605) 658-5541
- NPI assigned
- Oct 4, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0460 | SD | Primary |
Addresses
Primary practice location
414 E Clark St
Vermillion, SD 57069-2307
Mailing address
722 Lincoln St
Apt 200
Vermillion, SD 57069-2401
Phone (605) 658-5541
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0460 | SD | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475539200000",
"number": "1609325539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "722 LINCOLN ST",
"address_2": "APT 200",
"city": "VERMILLION",
"state": "SD",
"postal_code": "570692401",
"telephone_number": "605-658-5541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 E CLARK ST",
"city": "VERMILLION",
"state": "SD",
"postal_code": "570692307",
"telephone_number": "605-658-5541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACKEY",
"first_name": "IAN",
"middle_name": "DAVID",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-04",
"last_updated": "2016-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "SD",
"license": "0460",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vermillion, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.