1801895206 NPI number — DR. LAWRENCE W WHITLOCK MD

Table of content: DR. LAWRENCE W WHITLOCK MD (NPI 1801895206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801895206 NPI number — DR. LAWRENCE W WHITLOCK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITLOCK
Provider First Name:
LAWRENCE
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1801895206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1000 DEPT 362
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38148-0362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-373-9704
Provider Business Mailing Address Fax Number:
901-255-5223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3725 CHAMPION HILLS DR
Provider Second Line Business Practice Location Address:
SUITE 2000
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38125-2597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-367-9001
Provider Business Practice Location Address Fax Number:
901-565-8787
Provider Enumeration Date:
07/18/2005

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: 207R00000X , with the licence number:  8296 , 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: 93161 . This is a "BCBS AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 3159686 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4295606 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 512186 . This is a "VESTICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00122885 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110218393 . This is a "RAIL RAOD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3153163 . This is a "BCBST" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3151917 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106996001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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