1346643020 NPI number — LAWRENCE MEMORIAL HEALTH FOUNDATION INC.

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 1346643020 NPI number — LAWRENCE MEMORIAL HEALTH FOUNDATION INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE MEMORIAL HEALTH FOUNDATION 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:
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:
1346643020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2019
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:
870-886-1200
Provider Business Mailing Address Fax Number:
870-886-5340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N WALNUT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMBODEN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-869-3101
Provider Business Practice Location Address Fax Number:
870-869-3014
Provider Enumeration Date:
10/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
VANESSA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
870-886-1263

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , 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)





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