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  7. NPI Record 1154389815

DR. KEITH WOODWARD LACKEY MD
Complete NPI Record 1154389815
Internal Medicine in Charleston, SC


Quality Rating: 90.78 out of 100 score

NPI Status: Active since May 03, 2006

Contact Information

615 WESLEY DRIVE
SUITE 300
CHARLESTON, SC
ZIP 29407
Phone: (843) 266-4400
Fax: (843) 577-0455

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Name Prefix Text
  7. Provider Credential Text
  8. Provider First Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider Business Mailing Address Fax Number
  15. Provider First Line Business Practice Location Address
  16. Provider Second Line Business Practice Location Address
  17. Provider Business Practice Location Address City Name
  18. Provider Business Practice Location Address State Name
  19. Provider Business Practice Location Address Postal Code
  20. Provider Business Practice Location Address Country Code If outside U S
  21. Provider Business Practice Location Address Telephone Number
  22. Provider Business Practice Location Address Fax Number
  23. Provider Enumeration Date
  24. Last Update Date
  25. Provider Gender Code
  26. Healthcare Provider Taxonomy Code 1
  27. Provider License Number 1
  28. Provider License Number State Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Other Provider Identifier 1
  31. Other Provider Identifier Type Code 1
  32. Other Provider Identifier State 1
  33. Other Provider Identifier Issuer 1
  34. Other Provider Identifier 2
  35. Other Provider Identifier Type Code 2
  36. Other Provider Identifier State 2
  37. Other Provider Identifier Issuer 2
  38. Other Provider Identifier 3
  39. Other Provider Identifier Type Code 3
  40. Other Provider Identifier State 3
  41. Other Provider Identifier Issuer 3
  42. Other Provider Identifier 4
  43. Other Provider Identifier Type Code 4
  44. Other Provider Identifier State 4
  45. Is Sole Proprietor
  46. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1154389815. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1154389815
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: KEITH
The first name of the provider, if the provider is an individual.
Provider Middle Name: WOODWARD
The middle name of the provider, if the provider is an individual.
Provider Name Prefix Text: DR.
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text: MD
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: PO BOX 751649
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: CHARLOTTE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NC
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 282751649
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 8884720043
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 8437242440
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 615 WESLEY DRIVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 300
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: CHARLESTON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: SC
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 29407
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8432664400
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8435770455
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/3/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 4/23/2025
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 207R00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 15543
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: SC
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 110232037
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: SC
Other Provider Identifier Issuer 1: RR MEDICARE
Other Provider Identifier 2: 110105130
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: SC
Other Provider Identifier Issuer 2: RR MEDICARE
Other Provider Identifier 3: P00754364
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: SC
Other Provider Identifier Issuer 3: RAILROAD MC ID-RSFPN
Other Provider Identifier 4: 155432
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: SC
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 4/23/2025