MEDICARE: LAWRENCE MEMORIAL HOSPITAL

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1720106792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	325 MAINE ST
Second Line	:	MSO, LIBRARY
City	:	LAWRENCE
State	:	KS
Zip	:	66044
Country	:	US
Telephone Number	:	785-505-2988
Fax Number	:	785-505-3207

Provider Business Practice Location Address
First Line	:	406 AMES ST
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-3099
Country	:	US
Telephone Number	:	785-594-2512
Fax Number	:

Authorized Official
Title or Position	:	CRED SPEC
Name	:	MRS. AMY C MILLER
Credential	:	CPC
Telephone Number	:	785-505-2988

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	04/25/2014

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Directions to “LAWRENCE MEMORIAL HOSPITAL ” Practice Location

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