1265825004 NPI number — DRS. JOHNSTON & LAWRENCE

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 1265825004 NPI number — DRS. JOHNSTON & LAWRENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS. JOHNSTON & LAWRENCE
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:
1265825004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1610 W C PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72801-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-968-8338
Provider Business Mailing Address Fax Number:
479-968-1688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1610 W C PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72801-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-968-8338
Provider Business Practice Location Address Fax Number:
479-968-1688
Provider Enumeration Date:
03/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
479-968-8338

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  3422 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X , with the licence number: 2643 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 112087608 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150768608 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5X544 . This is a "ARKANSAS BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 56547 . This is a "ARKANSAS BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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