1366654253 NPI number — LAWRENCE FAMILY PRACTICE CENTER, PA

Table of content: (NPI 1366654253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366654253 NPI number — LAWRENCE FAMILY PRACTICE CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE FAMILY PRACTICE CENTER, PA
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:
1366654253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4951 W 18TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-832-2865
Provider Business Mailing Address Fax Number:
785-841-3129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4951 W 18TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66047-2090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-832-2865
Provider Business Practice Location Address Fax Number:
785-841-3129
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHANNING
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
785-841-6540

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110160 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 27765017 . This is a "BCBS OF KANSAS CITY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com