1164497350 NPI number — LAWRENCE MEMORIAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164497350 NPI number — LAWRENCE MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE MEMORIAL HOSPITAL
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:
1164497350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 839
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT RIDGE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72476-0839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-886-1252
Provider Business Mailing Address Fax Number:
870-886-3388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 SE LINDSEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOXIE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72433-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-886-4711
Provider Business Practice Location Address Fax Number:
870-886-4708
Provider Enumeration Date:
02/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SULLINS
Authorized Official First Name:
SANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
870-886-1263

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  C1982 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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