Provider Demographics
NPI:1366654253
Name:LAWRENCE FAMILY PRACTICE CENTER, PA
Entity Type:Organization
Organization Name:LAWRENCE FAMILY PRACTICE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-841-6540
Mailing Address - Street 1:4951 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047
Mailing Address - Country:US
Mailing Address - Phone:785-832-2865
Mailing Address - Fax:785-841-3129
Practice Address - Street 1:4951 W 18TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2090
Practice Address - Country:US
Practice Address - Phone:785-832-2865
Practice Address - Fax:785-841-3129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110160OtherBCBS
KS27765017OtherBCBS OF KANSAS CITY
KS27765017OtherBCBS OF KANSAS CITY
KS42672Medicare UPIN
KS110160OtherBCBS