Provider Demographics
NPI:1801430418
Name:FEDERAL CORRECTIONAL COMPLEX LOMPOC
Entity type:Organization
Organization Name:FEDERAL CORRECTIONAL COMPLEX LOMPOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SYSTEM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-735-2771
Mailing Address - Street 1:3901 KLEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-2706
Mailing Address - Country:US
Mailing Address - Phone:805-735-2771
Mailing Address - Fax:805-737-3105
Practice Address - Street 1:3901 KLEIN BLVD
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2706
Practice Address - Country:US
Practice Address - Phone:805-735-2771
Practice Address - Fax:805-737-3105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
01OtherFEDERAL PRISON