Provider Demographics
NPI:1649261215
Name:LAWNWOOD PAVILION PHYSICIAN SERVICES LLC
Entity type:Organization
Organization Name:LAWNWOOD PAVILION PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7625
Mailing Address - Street 1:1870 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4828
Mailing Address - Country:US
Mailing Address - Phone:772-467-3948
Mailing Address - Fax:772-467-3953
Practice Address - Street 1:1870 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4828
Practice Address - Country:US
Practice Address - Phone:772-467-3948
Practice Address - Fax:772-467-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD4729Medicare PIN
FLK7472Medicare PIN