Provider Demographics
NPI:1083897839
Name:LAWRENCE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:LAWRENCE MEMORIAL HOSPITAL
Other - Org Name:KREIDER REHABILITATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:785-840-3780
Mailing Address - Street 1:3510 CLINTON PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2195
Mailing Address - Country:US
Mailing Address - Phone:785-840-3780
Mailing Address - Fax:785-312-6707
Practice Address - Street 1:3510 CLINTON PL
Practice Address - Street 2:SUITE 110
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2195
Practice Address - Country:US
Practice Address - Phone:785-840-3780
Practice Address - Fax:785-312-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01884282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital