1629248372 NPI number — LAWRENCE RADIATION ONCOLOGY LLC

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 1629248372 NPI number — LAWRENCE RADIATION ONCOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE RADIATION ONCOLOGY 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:
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:
1629248372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 ARKANSAS
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66044-1335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-749-3600
Provider Business Mailing Address Fax Number:
785-749-3621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 ARKANSAS
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-1485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-749-3600
Provider Business Practice Location Address Fax Number:
785-749-3621
Provider Enumeration Date:
03/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KLISH
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OWNER/ MD
Authorized Official Telephone Number:
785-749-3600

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0431633 , 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: 200656390A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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