Provider Demographics
NPI:1174843254
Name:LAWRENCE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:LAWRENCE MEMORIAL HOSPITAL
Other - Org Name:LAWRENCE SPECIALTY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
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:785-840-0505
Mailing Address - Street 1:1402 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3529
Mailing Address - Country:US
Mailing Address - Phone:785-242-1707
Mailing Address - Fax:785-242-1709
Practice Address - Street 1:1402 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3529
Practice Address - Country:US
Practice Address - Phone:785-242-1707
Practice Address - Fax:785-242-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty