Provider Demographics
NPI:1427005990
Name:LAWRENCE R CURRY
Entity Type:Organization
Organization Name:LAWRENCE R CURRY
Other - Org Name:LAWRENCE R CURRY DBA MCKINLEY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-350-2180
Mailing Address - Street 1:524 E MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-6285
Mailing Address - Country:US
Mailing Address - Phone:574-256-2556
Mailing Address - Fax:574-258-4278
Practice Address - Street 1:524 E MCKINLEY AVE STE 1
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-6285
Practice Address - Country:US
Practice Address - Phone:574-256-2556
Practice Address - Fax:260-768-7214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-11-02
Deactivation Date:2007-12-07
Deactivation Code:
Reactivation Date:2008-01-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN735210OtherMEDICARE PTAN
IN000000101533OtherANTHEM BCBS
IN100092660Medicaid
IN000000101533OtherANTHEM BCBS