Healthcare Provider Details

I. General information

NPI: 1548281702
Provider Name (Legal Business Name): LAWRENCE USD 497
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MCDONALD DR
LAWRENCE KS
66044-1055
US

IV. Provider business mailing address

110 MCDONALD DR
LAWRENCE KS
66044-1063
US

V. Phone/Fax

Practice location:
  • Phone: 785-832-5008
  • Fax: 785-832-5016
Mailing address:
  • Phone: 785-832-5000
  • Fax: 785-832-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. KEVIN HARRELL
Title or Position: DIVISON DIRECTOR
Credential:
Phone: 785-832-5000