Organization
LAWRENCE CLINICAL LABORATORY CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL MODDRELL MD (PRESIDENT)
(785) 749-6100
Entity
Organization
Contact information
Practice address
325 MAINE ST, LAWRENCE, KS 66044-1360
(785) 749-6100
Mailing address
PO BOX 442157, LAWRENCE, KS 66044-8933
(316) 685-8428
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003981
BCBS
KS
01
—
CS1532
RAILROAD MEDICARE
—
Enumeration date
01/28/2006
Last updated
09/11/2025
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