Provider Demographics
NPI:1356469340
Name:LAWRENCE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:LAWRENCE MEMORIAL HOSPITAL
Other - Org Name:FAMILY PRACTICE OF TONGANOXIE
Other - Org Type:Doing Business As
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 1:410 WOODFIELD
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-5443
Practice Address - Country:US
Practice Address - Phone:913-845-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110332Medicare PIN