Healthcare Provider Details

I. General information

NPI: 1811082670
Provider Name (Legal Business Name): LAWRENCE R CURRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 E MCKINLEY AVE
MISHAWAKA IN
46545-6285
US

IV. Provider business mailing address

524 E MCKINLEY AVE
MISHAWAKA IN
46545-6285
US

V. Phone/Fax

Practice location:
  • Phone: 574-256-2556
  • Fax: 574-258-4278
Mailing address:
  • Phone: 574-256-2556
  • Fax: 574-258-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02000570A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSEMARIE SCOTT
Title or Position: ADMINISTRATOR
Credential:
Phone: 260-350-2180