1366402661 NPI number — LAWRENCE ROBERT WOOD APRN-BC

Table of content: LAWRENCE ROBERT WOOD APRN-BC (NPI 1366402661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366402661 NPI number — LAWRENCE ROBERT WOOD APRN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
LAWRENCE
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC
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:
1366402661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1393 CELANESE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29732-1722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-329-3103
Provider Business Mailing Address Fax Number:
803-325-2232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1393 CELANESE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29732-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-329-3103
Provider Business Practice Location Address Fax Number:
803-325-2232
Provider Enumeration Date:
03/23/2006

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: 363L00000X , with the licence number:  APN 1074 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LF0000X , with the licence number: APN 1074 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LX0106X , with the licence number: APN 1074 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: NP0536 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: D4220 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".