Provider Demographics
NPI:1639204498
Name:LAWRENCE JOSEPH GOTTS DO PLLC
Entity Type:Organization
Organization Name:LAWRENCE JOSEPH GOTTS DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:270-726-4444
Mailing Address - Street 1:1621 S NASHVILLE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276
Mailing Address - Country:US
Mailing Address - Phone:270-726-4444
Mailing Address - Fax:270-726-4400
Practice Address - Street 1:1621 S NASHVILLE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276
Practice Address - Country:US
Practice Address - Phone:270-726-4444
Practice Address - Fax:270-726-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080160808OtherRAILROAD
KY000000176043OtherBCBS
KY64010895Medicaid
KY64010895Medicaid
KY1837202Medicare PIN