Provider Demographics
NPI:1447428594
Name:LAWRENCE F HELTON. DPM
Entity Type:Organization
Organization Name:LAWRENCE F HELTON. DPM
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-779-5263
Mailing Address - Street 1:761 GOLF VIEW DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9655
Mailing Address - Country:US
Mailing Address - Phone:541-779-5263
Mailing Address - Fax:541-779-0555
Practice Address - Street 1:761 GOLF VIEW DR UNIT A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9655
Practice Address - Country:US
Practice Address - Phone:541-779-5263
Practice Address - Fax:541-779-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00090332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR086397Medicaid
0947730001Medicare NSC
ORT67710Medicare UPIN