Lawrence Medical Group
Organization Active NPI Family Medicine Physician · Oceana, WY
NPI 1952149676 · NPPES record last updated Mar 12, 2025
Key facts
- NPI
- 1952149676
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- LAWRENCE MEDICAL GROUP
- Practice address
- 1700 Cook Parkway
Suite 1
Oceana, WY 24870 - Phone
- (304) 601-5549
- Fax
- (304) 310-1599
- NPI assigned
- Jul 17, 2024
- Organization subpart
- No
Authorized official
- Name
- Wendy White
- Title
- Credentialing Specialist
- Phone
- (304) 688-7027
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D2314122 | Lawrence Medical Group / Renegade Health | Certificate of waiver | Nov 13, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241205001904 | WV | Part B Supplier - Clinic/Group Practice | 9133655806 |
Receives reassigned benefits from 1 practitioner Practice locations: Mounty Gay, WV |
| O20260214000397 | WV | Part B Supplier - Clinic/Group Practice | 7810477270 |
Receives reassigned benefits from 1 practitioner Practice locations: Oceana, WV |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1700 Cook Parkway
Suite 1
Oceana, WY 24870
Mailing address
PO Box 301
Mount Gay, WV 25637-0301
Phone (304) 688-7027
Other practice location 1
182 Mathis Addition
Mount Gay, WV 25637
Phone (304) 601-5549
Other names
- RENEGADE HEALTH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.