MEDICARE: LAWLEY DRUG & MEDICAL HOSPICE, LLC

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1487843793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWLEY DRUG & MEDICAL HOSPICE, LLC

Provider Business Mailing Address
First Line	:	1250 HIGHWAY 77
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-0405
Country	:	US
Telephone Number	:	256-413-4473
Fax Number	:	256-413-7358

Provider Business Practice Location Address
First Line	:	1250 HIGHWAY 77
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-0405
Country	:	US
Telephone Number	:	256-413-4473
Fax Number	:	256-413-7358

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. BRENT ALLEN LAWLEY
Credential	:
Telephone Number	:	256-413-4473

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	08/07/2008

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