Provider Demographics
NPI:1366081325
Name:RICKY P. LOCKETT, D.O, PA
Entity type:Organization
Organization Name:RICKY P. LOCKETT, D.O, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-896-8686
Mailing Address - Street 1:1501 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-2008
Mailing Address - Country:US
Mailing Address - Phone:727-452-9526
Mailing Address - Fax:813-200-8449
Practice Address - Street 1:2822 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6330
Practice Address - Country:US
Practice Address - Phone:727-452-9526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICKY P. LOCKETT, D.O, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-22
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service