1518961234 NPI number — DR. LAWRENCE C PRICE M.D.

Table of content: DR. LAWRENCE C PRICE M.D. (NPI 1518961234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518961234 NPI number — DR. LAWRENCE C PRICE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
LAWRENCE
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1518961234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
612 S 12TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT SMITH
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72901-4702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-785-2431
Provider Business Mailing Address Fax Number:
479-494-7787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 S E ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72901-4716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-785-2431
Provider Business Practice Location Address Fax Number:
479-494-7787
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  R-1927 , 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)

  • Identifier: 01625591 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4614448 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100086980A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1354120 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 54150 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 105637001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12640000000 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1632210 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5668904002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110177873 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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