Basic Information
| Provider Information | |||||||||
| NPI: | 1821206194 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAWRENCE VEIN CENTER, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 346 MAINE ST | ||||||||
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| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858568346 | ||||||||
| FaxNumber: | 7858420348 | ||||||||
| Practice Location | |||||||||
| Address1: | 346 MAINE ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858568346 | ||||||||
| FaxNumber: | 7858420348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DENNING | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7858568346 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 04-20141 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.