Provider Demographics
NPI:1437153038
Name:CITY OF LAWRENCE
Entity Type:Organization
Organization Name:CITY OF LAWRENCE
Other - Org Name:LAWRENCE DOUGLAS COUNTY FIRE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-830-7000
Mailing Address - Street 1:1911 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-2516
Mailing Address - Country:US
Mailing Address - Phone:785-830-7000
Mailing Address - Fax:785-830-7090
Practice Address - Street 1:1911 STEWART AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046
Practice Address - Country:US
Practice Address - Phone:785-830-7000
Practice Address - Fax:785-830-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100273470-AMedicaid
KS119992OtherBC BS OF KANSAS
KS590010886OtherRAILROAD MEDICARE