1427217611 NPI number — B. BROOKS LAWRENCE, M.D., P.A.

Table of content: (NPI 1427217611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427217611 NPI number — B. BROOKS LAWRENCE, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B. BROOKS LAWRENCE, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1427217611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10581
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72034-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-327-6900
Provider Business Mailing Address Fax Number:
501-327-3690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72034-7272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-327-6900
Provider Business Practice Location Address Fax Number:
501-327-3690
Provider Enumeration Date:
06/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LAWRENCE
Authorized Official First Name:
B
Authorized Official Middle Name:
BROOKS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-327-6900

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C8006 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 16918000000 . This is a "QUAL CHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5K059 . This is a "HEALTH ADVANTAGE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 129592002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 432352883 . This is a "NOVASYS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 7464032 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 392651 . This is a "HEALTH LINK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 0722160002 . This is a "CIGNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: FP98253 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5K059 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com