NPIMap

Organization Active NPI

Charles P. Lawless, M.D., P.a.

  • Specialist
  • Pocatello, ID
National Provider Identifier
1629280359
Registry record updated Dec 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
M-3434 Issued in ID
Legal business name
CHARLES P. LAWLESS, M.D., P.A.
Practice address
1777 E Clark St Ste 310
Pocatello, ID 83201-3357
Phone
(208) 232-4133
Fax
(208) 233-5736
NPI assigned
May 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles Pittman Lawless, M.D.
Title
President
Phone
(208) 232-4133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X M-3434 ID Primary

Addresses

Primary practice location

1777 E Clark St Ste 310
Pocatello, ID 83201-3357

Mailing address

1777 E Clark St Ste 310
Pocatello, ID 83201-3357
Phone (208) 232-4133

Other identifiers 2

IdentifierTypeStateIssuer
000010005308OtherIDREGENCE BLUE SHIELD OF ID
07302OtherIDBLUE CROSS OF IDAHO

Other names 1

  • WALT'S OPTICAL SHOP Doing business as

National Provider Directory

National Provider Directory

Locations

1777 E Clark St
Ste 310
Pocatello, ID 83201
Phone (208) 232-4133

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196640000000",
    "number": "1629280359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 E CLARK ST STE 310",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013357",
            "telephone_number": "208-232-4133",
            "fax_number": "208-233-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 E CLARK ST STE 310",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013357",
            "telephone_number": "208-232-4133",
            "fax_number": "208-233-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES P. LAWLESS, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-12-03",
        "status": "A",
        "authorized_official_last_name": "LAWLESS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "PITTMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-232-4133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "M-3434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD OF ID",
            "identifier": "000010005308",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "07302",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALT'S OPTICAL SHOP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.