Organization
LAWRENCE P JENNINGS M D M S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE P JENNINGS M.D. (PRESIDENT)
(618) 262-5113
Entity
Organization
Contact information
Practice address
1430 COLLEGE DR, SUITE A, MOUNT CARMEL, IL 62863-2649
(618) 262-5113
(618) 263-3195
Mailing address
1430 COLLEGE DR, SUITE A, MOUNT CARMEL, IL 62863-2649
(618) 262-5113
(618) 263-3195
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036063272
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09320171
BLUE CROSS BLUE SHIELD
IL
01
—
P00169369
MEDICARE RAILROAD
IL
Enumeration date
05/02/2006
Last updated
04/08/2010
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