1164479077 NPI number — LAWSON FAMILY PRACTICE, INC.

Table of content: (NPI 1164479077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164479077 NPI number — LAWSON FAMILY PRACTICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWSON FAMILY PRACTICE, INC.
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:
1164479077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 484
Provider Second Line Business Mailing Address:
411 N PENNSYLVANIA AVE
Provider Business Mailing Address City Name:
LAWSON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64062-0484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-580-4081
Provider Business Mailing Address Fax Number:
816-580-0013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 N PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWSON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64062-9402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-580-4081
Provider Business Practice Location Address Fax Number:
816-580-0013
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANTRELL
Authorized Official First Name:
SIDNEY
Authorized Official Middle Name:
ALLEN RHEA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-580-4081

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  R9D24 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DG0442 . This is a "MEDICARE RAILROAD GROUP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: BLUE CROSS KC . This is a "33017015" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: DG0442 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com