Basic Information
Provider Information
NPI: 1285253492
EntityType: 2
ReplacementNPI:  
OrganizationName: LAWRENCE PHYSICIANS LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: FIRST MED LMH HEALTH
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 MAINE ST
Address2: MSO, LIBRARY
City: LAWRENCE
State: KS
PostalCode: 66044
CountryCode: US
TelephoneNumber: 7855052988
FaxNumber: 7855055228
Practice Location
Address1: 3211 S IOWA ST STE 100
Address2:  
City: LAWRENCE
State: KS
PostalCode: 660465205
CountryCode: US
TelephoneNumber: 7855055475
FaxNumber: 7855055326
Other Information
ProviderEnumerationDate: 04/09/2020
LastUpdateDate: 04/09/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MILLER
AuthorizedOfficialFirstName: AMY
AuthorizedOfficialMiddleName: C
AuthorizedOfficialTitleorPosition: CODING OPERATIONS MANAGER
AuthorizedOfficialTelephone: 7855052988
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/09/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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