1235111279 NPI number — DR. BRIAN C LAWLER MD

Table of content: DR. BRIAN C LAWLER MD (NPI 1235111279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235111279 NPI number — DR. BRIAN C LAWLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWLER
Provider First Name:
BRIAN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235111279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 932163
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44193-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-412-4000
Provider Business Mailing Address Fax Number:
586-412-4100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL VILLAGE DR
Provider Second Line Business Practice Location Address:
ATTN: RADIOLOGY DEPT
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-2160
Provider Business Practice Location Address Fax Number:
859-301-3932
Provider Enumeration Date:
11/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  36672 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 36672 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64035462 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0060577 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00844270 . This is a "RR MEDICARE PTAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".