MEDICARE: LAWSON FAMILY PRACTICE, INC.

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	R9D24	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DG0442	OTHER	MO	MEDICARE RAILROAD GROUP
3	DG0442	OTHER	MO	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	BLUE CROSS KC	OTHER	MO	33017015

General Provider Information

NPI Number	:	1164479077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWSON FAMILY PRACTICE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 484
Second Line	:	411 N PENNSYLVANIA AVE
City	:	LAWSON
State	:	MO
Zip	:	64062-0484
Country	:	US
Telephone Number	:	816-580-4081
Fax Number	:	816-580-0013

Provider Business Practice Location Address
First Line	:	411 N PENNSYLVANIA AVE
Second Line	:
City	:	LAWSON
State	:	MO
Zip	:	64062-9402
Country	:	US
Telephone Number	:	816-580-4081
Fax Number	:	816-580-0013

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SIDNEY ALLEN RHEA CANTRELL
Credential	:	D.O.
Telephone Number	:	816-580-4081

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	11/27/2007

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Directions to “LAWSON FAMILY PRACTICE, INC. ” Practice Location

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