Provider Demographics
NPI:1164479077
Name:LAWSON FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:LAWSON FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:ALLEN RHEA
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-580-4081
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:411 N PENNSYLVANIA AVE
Mailing Address - City:LAWSON
Mailing Address - State:MO
Mailing Address - Zip Code:64062-0484
Mailing Address - Country:US
Mailing Address - Phone:816-580-4081
Mailing Address - Fax:816-580-0013
Practice Address - Street 1:411 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LAWSON
Practice Address - State:MO
Practice Address - Zip Code:64062-9402
Practice Address - Country:US
Practice Address - Phone:816-580-4081
Practice Address - Fax:816-580-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9D24207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODG0442OtherMEDICARE RAILROAD GROUP
MOBLUE CROSS KCOther33017015
MODG0442OtherMEDICARE RAILROAD
MODG0442OtherMEDICARE RAILROAD GROUP