Provider Demographics
NPI:1326064940
Name:WARREN L LOWRY SC
Entity Type:Organization
Organization Name:WARREN L LOWRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-397-6642
Mailing Address - Street 1:1340 CHARLES ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2200
Mailing Address - Country:US
Mailing Address - Phone:815-397-6642
Mailing Address - Fax:815-397-6659
Practice Address - Street 1:1340 CHARLES ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2200
Practice Address - Country:US
Practice Address - Phone:815-397-6642
Practice Address - Fax:815-397-6659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036038948208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036038948Medicaid
IL10120361OtherBLUE CROSS BLUE SHIELD
IL791342073OtherRAILROAD MEDICARE PALMETT
IL036038948Medicaid
ILD10337Medicare UPIN
IL254020Medicare PIN