Provider Demographics
NPI:1164747598
Name:LAWRENCE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:LAWRENCE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED SPEC
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:785-505-2988
Mailing Address - Street 1:325 MAINE ST
Mailing Address - Street 2:MSO, LIBRARY
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-3207
Practice Address - Street 1:1130 W 4TH ST
Practice Address - Street 2:SUITE 2051
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1328
Practice Address - Country:US
Practice Address - Phone:785-856-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE VEIN CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-29
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS20121208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty