Provider Demographics
NPI:1780011460
Name:FAMILY MEDICAL CARE OF LAWRENCE COUNTY, INC
Entity Type:Organization
Organization Name:FAMILY MEDICAL CARE OF LAWRENCE COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LARIMER
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:724-946-3564
Mailing Address - Street 1:150 N NEW CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1019
Mailing Address - Country:US
Mailing Address - Phone:724-946-3564
Mailing Address - Fax:724-946-2156
Practice Address - Street 1:150 N NEW CASTLE ST
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-1019
Practice Address - Country:US
Practice Address - Phone:724-946-3564
Practice Address - Fax:724-946-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013176363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty