Provider Demographics
NPI:1689939605
Name:MIDWEST DIVISION-LRHC LLC
Entity Type:Organization
Organization Name:MIDWEST DIVISION-LRHC LLC
Other - Org Name:LAFAYETTE REGIONAL HEALTH CENTER RADIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-259-2203
Mailing Address - Street 1:1500 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1107
Mailing Address - Country:US
Mailing Address - Phone:660-259-2203
Mailing Address - Fax:660-259-6813
Practice Address - Street 1:1500 STATE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1107
Practice Address - Country:US
Practice Address - Phone:660-259-2203
Practice Address - Fax:660-259-6813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST DIVISION-LRHC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-05
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty