Provider Demographics
NPI:1376635953
Name:LAWRENCE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:LAWRENCE MEMORIAL HOSPITAL
Other - Org Name:FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD - CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-878-6485
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:1309 WEST MAIN ST
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-0839
Mailing Address - Country:US
Mailing Address - Phone:870-886-1200
Mailing Address - Fax:870-886-5340
Practice Address - Street 1:1309 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-0839
Practice Address - Country:US
Practice Address - Phone:870-886-1200
Practice Address - Fax:870-886-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135300729Medicaid
5B684Medicare ID - Type Unspecified