1952149676 NPI number — LAWRENCE MEDICAL GROUP

Table of content: (NPI 1952149676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952149676 NPI number — LAWRENCE MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE MEDICAL GROUP
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:
1952149676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT GAY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25637-0301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-688-7027
Provider Business Mailing Address Fax Number:
304-310-1599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 COOK PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
OCEANA
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
24870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-601-5549
Provider Business Practice Location Address Fax Number:
304-310-1599
Provider Enumeration Date:
07/17/2024

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
304-688-7027

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)





Copyright © 2007-2025 www.npivalidator.com