1346243680 NPI number — LAWRENCE SURGERY CENTER LLC

Table of content: (NPI 1346243680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346243680 NPI number — LAWRENCE SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE SURGERY CENTER 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:
1346243680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6265 ROCK CHALK DR
Provider Second Line Business Mailing Address:
SUITE 2100
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66049-5232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-832-0588
Provider Business Mailing Address Fax Number:
785-832-2029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6265 ROCK CHALK DR
Provider Second Line Business Practice Location Address:
STE 2100
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66049-5232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-832-0588
Provider Business Practice Location Address Fax Number:
785-832-2029
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
LEISA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
785-832-0588

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  S023002 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 144083900 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 1511 . This is a "FEDERAL BCBS PROV. #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 390320 . This is a "FIRSTGUARD PROV. #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 130326 . This is a "BCBS KS PROV. #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100372910A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90932017 . This is a "BCBS KC PROV. #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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