Provider Demographics
NPI:1801077672
Name:LAWRENCE MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:LAWRENCE MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRED SPEC
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:985-505-2988
Mailing Address - Street 1:325 MAINE ST
Mailing Address - Street 2:MSO, LIBRARY
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-3207
Practice Address - Street 1:313 S UNION ST
Practice Address - Street 2:
Practice Address - City:MC LOUTH
Practice Address - State:KS
Practice Address - Zip Code:66054-4103
Practice Address - Country:US
Practice Address - Phone:913-796-6116
Practice Address - Fax:913-796-2222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-20
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-59692-09364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty