Basic Information
| Provider Information | |||||||||
| NPI: | 1710133970 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAWRENCE A. PABST, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 704 | ||||||||
| Address2: | |||||||||
| City: | GALION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448330704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194677059 | ||||||||
| FaxNumber: | 4194686962 | ||||||||
| Practice Location | |||||||||
| Address1: | 955 HOSFORD RD | ||||||||
| Address2: | |||||||||
| City: | GALION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448339325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194687059 | ||||||||
| FaxNumber: | 4194686962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2008 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | PABST | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4194687059 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35038318 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0398878 | 05 | OH | MEDICAID |