MEDICARE: AGEWELL GERIATRICS

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
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1447027362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGEWELL GERIATRICS

Provider Business Mailing Address
First Line	:	793 NW 1621ST RD
Second Line	:
City	:	BATES CITY
State	:	MO
Zip	:	64011-8395
Country	:	US
Telephone Number	:	816-226-1182
Fax Number	:

Provider Business Practice Location Address
First Line	:	793 NW 1621ST RD
Second Line	:
City	:	BATES CITY
State	:	MO
Zip	:	64011-8395
Country	:	US
Telephone Number	:	816-226-1182
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JAMES LAWRENZI
Credential	:	DO
Telephone Number	:	573-381-0305

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	11/20/2024

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Directions to “AGEWELL GERIATRICS ” Practice Location

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