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NPI Code Detail

MEDICARE: LAWRENCE CLINICAL LABORATORY CHARTERED

MEDICARE: LAWRENCE CLINICAL LABORATORY CHARTERED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician
2207ZP0105XClinical Pathology/Laboratory Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CS1532OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1003981OTHERKSBCBS

General Provider Information

NPI Number : 1417928433
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAWRENCE CLINICAL LABORATORY CHARTERED
Provider Business Mailing Address
First Line : PO BOX 442157
Second Line :
City : LAWRENCE
State : KS
Zip : 66044-8933
Country : US
Telephone Number : 316-685-8428
Fax Number :
Provider Business Practice Location Address
First Line : 325 MAINE ST
Second Line :
City : LAWRENCE
State : KS
Zip : 66044-1360
Country : US
Telephone Number : 785-749-6100
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CAROL MODDRELL
Credential : MD
Telephone Number : 785-749-6100
Provider Enumeration Date : 01/28/2006
Last Update Date : 09/11/2025

Similar Medicare Providers

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Practice Location Address:
325 MAINE ST
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Practice Fax:
1265482053 — SHARI QUICK M.D.
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1962473991 — RICHARD GALBRAITH MD
Practice Location Address:
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Practice Fax:
1457322232 — MICHAEL THOMPSON MD
Practice Location Address:
325 MAINE ST
LAWRENCE, KS
66044-1360
Practice Phone: 785-749-6100
Practice Fax:
1871567636 — KELLY A SCHMIDT ARNP
Practice Location Address:
325 MAINE ST
LAWRENCE, KS
66044-1360
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1326094319 — SALLY A. MCGEE ARNP,BC
Practice Location Address:
325 MAINE ST
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Practice Fax: 785-505-2874

Directions to “LAWRENCE CLINICAL LABORATORY CHARTERED ” Practice Location

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