MEDICARE: LAWRENCE MEMORIAL HOSPITAL

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

General Provider Information

NPI Number	:	1295853216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	325 MAINE ST
Second Line	:	MSO, LIBRARY
City	:	LAWRENCE
State	:	KS
Zip	:	66044
Country	:	US
Telephone Number	:	785-505-2988
Fax Number	:	785-505-3207

Provider Business Practice Location Address
First Line	:	3510 CLINTON PL
Second Line	:	SUITE 210
City	:	LAWRENCE
State	:	KS
Zip	:	66047-2195
Country	:	US
Telephone Number	:	785-842-5070
Fax Number	:

Authorized Official
Title or Position	:	CRED SPEC
Name	:	MRS. AMY C MILLER
Credential	:
Telephone Number	:	785-505-2988

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	04/25/2014

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