Provider Demographics
NPI:1548281702
Name:LAWRENCE USD 497
Entity type:Organization
Organization Name:LAWRENCE USD 497
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISON DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-832-5000
Mailing Address - Street 1:110 MCDONALD DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1063
Mailing Address - Country:US
Mailing Address - Phone:785-832-5000
Mailing Address - Fax:785-832-5016
Practice Address - Street 1:110 MCDONALD DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1055
Practice Address - Country:US
Practice Address - Phone:785-832-5008
Practice Address - Fax:785-832-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100212010AMedicaid