1679525620 NPI number — MR. LAWRENCE ANTHONY STRONG CRNA

Table of content: MR. LAWRENCE ANTHONY STRONG CRNA (NPI 1679525620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679525620 NPI number — MR. LAWRENCE ANTHONY STRONG CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRONG
Provider First Name:
LAWRENCE
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1679525620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1755 KIRBY PKWY
Provider Second Line Business Mailing Address:
#330
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38120-8300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-725-5846
Provider Business Mailing Address Fax Number:
901-726-4827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1755 KIRBY PKWY
Provider Second Line Business Practice Location Address:
#330
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-725-5846
Provider Business Practice Location Address Fax Number:
901-726-4827
Provider Enumeration Date:
05/17/2006

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: 367500000X , with the licence number:  APN 11204 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3902350 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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