1922049782 NPI number — LAWTON MED PARTNERS LLC

Table of content: (NPI 1922049782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922049782 NPI number — LAWTON MED PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWTON MED PARTNERS 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:
6
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:
1922049782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 CHURCH ST
Provider Second Line Business Mailing Address:
SUITE 1900
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37219-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-777-8201
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
924 SW 38TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73505-7021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-351-1716
Provider Business Practice Location Address Fax Number:
580-351-1716
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
214-736-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200100390A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203035986001 . This is a "BC-BS OF OKLAHOMA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com