1528044161 NPI number — TINA M. LAWSON M.D.

Table of content: TINA M. LAWSON M.D. (NPI 1528044161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528044161 NPI number — TINA M. LAWSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWSON
Provider First Name:
TINA
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWSON
Provider Other First Name:
TINA
Provider Other Middle Name:
WALLS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528044161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2330 S DIXON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KOKOMO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46902-6434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-455-5400
Provider Business Mailing Address Fax Number:
765-865-3710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17300 WESTFIELD BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46074-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-582-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2005

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:  01044162A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200009320 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7907 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 3937240023 . This is a "MEDICAREDMEPOS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00315370 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000368345 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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