1427005990 NPI number — LAWRENCE R CURRY

Table of content: (NPI 1427005990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427005990 NPI number — LAWRENCE R CURRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE R CURRY
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:
LAWRENCE R CURRY DBA MCKINLEY MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
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:
1427005990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/07/2007
NPI Reactivation Date:
01/15/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 E MCKINLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISHAWAKA
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46545-6285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-256-2556
Provider Business Mailing Address Fax Number:
574-258-4278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 E MCKINLEY AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46545-6285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-256-2556
Provider Business Practice Location Address Fax Number:
260-768-7214
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
ROSEMARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
260-350-2180

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 735210 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000101533 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100092660 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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