Mario Lucero, MD
Individual provider Active NPI Ph.D. Medical Genetics · War, WV
NPI 1639173115 · NPPES record last updated Mar 13, 2008
Key facts
- NPI
- 1639173115
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Ph.D. Medical Genetics 170100000X
- License
- WV13411 (WV)
- Practice address
- Route 16, Main Street
War, WV 24892 - Phone
- (304) 425-1768
- Fax
- (304) 425-3912
- NPI assigned
- Jun 13, 2005
- Reactivated
- Apr 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111029000017 | WV | Practitioner - General Practice | 0042483596 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WV13411 | WV | MD | Ph.D. Medical Genetics |
| WV 13411 | WV | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercer County Health Department | Current |
Accepting new patients | |
| War Family Clinic | Past | Accepting new patients |
Locations
978 Blue Prince Rd
Bluefield, WV 24701
Phone (304) 324-8367
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | WV 13411 | WV | |
| Ph.D. Medical Genetics | 170100000X | WV13411 | WV | Yes |
Addresses
Primary practice location
Route 16, Main Street
War, WV 24892
Mailing address
Route 16, Main Street
War, WV 24892
Phone (304) 425-1768
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0049852000 | Medicaid | WV |
Other providers in War, WV
- Dry Fork Squad
- Autumn Lea Edwards
- Bobbi Sue Greer
- Amanda Noel Hagerman
- Barbara Holt
- Sergio Capuno Macatangay
- Mahesh B. Patel
- McDowell Pharmacy Inc
- Miners City Clinic
- Leslie Lynn Poe
All providers in War, WV · Ph.D. Medical Genetics in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.