1689676504 NPI number — RICK J LAWSON M.D.

Table of content: RICK J LAWSON M.D. (NPI 1689676504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689676504 NPI number — RICK J LAWSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWSON
Provider First Name:
RICK
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1689676504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 909
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40201-0909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-569-7983
Provider Business Mailing Address Fax Number:
502-589-4989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ABRAHAM FLEXNER WAY
Provider Second Line Business Practice Location Address:
HMA DEPT.
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-569-7983
Provider Business Practice Location Address Fax Number:
502-589-4989
Provider Enumeration Date:
08/11/2005

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: 207Q00000X , with the licence number:  33029 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 33029 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200227020 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009178 . This is a "SHIO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000823035 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2818095000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50013891 . This is a "PASSORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00389393 . This is a "MCR - RR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5307902 . This is a "CIGNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64330293 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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