Basic Information
| Provider Information | |||||||||
| NPI: | 1528018918 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAWRENCE FAMILY MEDICINE & OBSTETRICS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 BILTMORE DR | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660491995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853311700 | ||||||||
| FaxNumber: | 7853311799 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 BILTMORE DR | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660491995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853311700 | ||||||||
| FaxNumber: | 7853311799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 07/18/2015 | ||||||||
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| AuthorizedOfficialLastName: | KIMURI | ||||||||
| AuthorizedOfficialFirstName: | LARISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7853311700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200004810A | 05 | KS | MEDICAID |