=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316354640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAWRENCE PHYSICIANS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2014
-----------------------------------------------------
Last Update Date | 12/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 MAINE ST
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66044-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-505-6299
-----------------------------------------------------
Fax | 785-505-5221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 MAINE ST
-----------------------------------------------------
City | LAWRENCE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66044-1360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-505-6299
-----------------------------------------------------
Fax | 785-505-5221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INSURANCE CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | MRS. HEATHER BAHNMAIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-505-2988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------