Provider Demographics
NPI:1922371442
Name:LOWRY MEDICAL CLINIC
Entity Type:Organization
Organization Name:LOWRY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SLATER
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD PLLC
Authorized Official - Phone:662-244-8864
Mailing Address - Street 1:362 PARK CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705
Mailing Address - Country:US
Mailing Address - Phone:662-244-8864
Mailing Address - Fax:662-328-4149
Practice Address - Street 1:362 PARK CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705
Practice Address - Country:US
Practice Address - Phone:662-244-8864
Practice Address - Fax:662-328-4149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:11050
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11050261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS110001423Medicare PIN