1568465086 NPI number — JOHN P. LAWLOR, DDS, PC

Table of content: (NPI 1568465086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568465086 NPI number — JOHN P. LAWLOR, DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN P. LAWLOR, DDS, PC
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:
1568465086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1179
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47670-0879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-385-2990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47670-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-385-2990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAWLOR
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-385-2990

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  54000883A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X , with the licence number: 54000883A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000591046 . This is a "UNITED CONCORDIA INS." identifier . This identifiers is of the category "OTHER".
  • Identifier: 02025 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200902070 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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