1841281821 NPI number — LAWSON MEDICAL LLC

Table of content: (NPI 1841281821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841281821 NPI number — LAWSON MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWSON MEDICAL LLC
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:
1841281821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1821 OLD DONATION PKWY
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23454-3033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-631-6311
Provider Business Mailing Address Fax Number:
757-631-2659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1821 OLD DONATION PKWY
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23454-3033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-631-6311
Provider Business Practice Location Address Fax Number:
757-631-2659
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAWSON
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/ CEO
Authorized Official Telephone Number:
757-631-6311

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2004165006R , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000023989 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2119348 . This is a "MAMSI/OPTIMUM CH/ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 605836500 . This is a "ACS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7703566 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4254 . This is a "ELDER HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E2371 . This is a "PRINCE WILLIAM COUNTY SCO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0341344 00 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101160020 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1931635 . This is a "CIGNA HEALTHCARE ID NUMBE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 276746 . This is a "ANTHEM BLUE CROSS B/S" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 64178 . This is a "OPTIMA HEALTH CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: G00271 . This is a "EMPIRE BLUE CROSS OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 009111018 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4032420 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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