Provider Demographics
NPI:1881626935
Name:LAWRENCE K BUTCHER PSC
Entity type:Organization
Organization Name:LAWRENCE K BUTCHER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:KING
Authorized Official - Last Name:BUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:606-337-1313
Mailing Address - Street 1:850 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1430
Mailing Address - Country:US
Mailing Address - Phone:606-337-1313
Mailing Address - Fax:606-337-1314
Practice Address - Street 1:850 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1430
Practice Address - Country:US
Practice Address - Phone:606-337-1313
Practice Address - Fax:606-337-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19286207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000047492OtherANTHEM BLUESHIELD
KY2191920OtherUMWA
KY64192867Medicaid
KY64192867Medicaid
KY2191920OtherUMWA