Healthcare Provider Details

I. General information

NPI: 1720106792
Provider Name (Legal Business Name): LAWRENCE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 04/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 AMES ST
BALDWIN CITY KS
66006-3099
US

IV. Provider business mailing address

325 MAINE ST MSO, LIBRARY
LAWRENCE KS
66044
US

V. Phone/Fax

Practice location:
  • Phone: 785-594-2512
  • Fax:
Mailing address:
  • Phone: 785-505-2988
  • Fax: 785-505-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY C MILLER
Title or Position: CRED SPEC
Credential: CPC
Phone: 785-505-2988