Provider Demographics
NPI:1811082670
Name:LAWRENCE R CURRY
Entity type:Organization
Organization Name:LAWRENCE R CURRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-350-2180
Mailing Address - Street 1:524 E MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-6285
Mailing Address - Country:US
Mailing Address - Phone:574-256-2556
Mailing Address - Fax:574-258-4278
Practice Address - Street 1:524 E MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-6285
Practice Address - Country:US
Practice Address - Phone:574-256-2556
Practice Address - Fax:574-258-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IN02000570A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN735210OtherMEDICARE PTAN
IN100092660Medicaid
IN000000101533OtherANTHEM BCBS
INE33555Medicare UPIN