LARS T CONWAY (NPI# 1679534432) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679534432 |
| Entity Type | Individual |
| Full Name | LARS T CONWAY |
| Credential | MD |
| Practice Address |
625 E Broadway Ave Jackson WY 83001-8642 |
| Mailing Address |
Po Box 4940 625 E Broadway Jackson WY 83001-4940 |
| Practice Telephone | 3077336418 |
| Practice Fax Number | 3077340885 |
| Mailing Telephone | 3077336418 |
| Mailing Fax Number | 3077340885 |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2014-08-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ZC0500X |
Pathology Specialization: Cytopathology |
27443 | MN | Allopathic & Osteopathic Physicians |
| N | 207ZP0101X |
Pathology Specialization: Anatomic Pathology |
9164A | WY | Allopathic & Osteopathic Physicians |
| Y | 207ZP0101X |
Pathology Specialization: Anatomic Pathology |
27443 | MN | Allopathic & Osteopathic Physicians |
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
M-12068 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 936780200 | 05 | |
| MN | BCBS | 03069C0 | 01 |
| MN | RR MEDICARE | 220007425 | 01 |
| Street Address |
625 E BROADWAY AVE |
| City | JACKSON |
| State | WY |
| Zip Code | 83001-8642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154969251 | Michelle Robertson | Dietitian, Registered | 625 E Broadway Ave, Jackson, WY 83001-8642 | 2019-12-19 |
| 1942848072 | Anna Sigrid Eide | Dietitian, Registered | 625 E Broadway Ave, Jackson, WY 83001-8642 | 2019-12-19 |
| 1104464734 | Lisa Lauritzen Smith | Dietitian, Registered | 625 E Broadway Ave, Jackson, WY 83001-8642 | 2019-12-13 |
| 1598325193 | Katrina Rush | Occupational Therapist | 625 E Broadway Ave, Jackson, WY 83001-8642 | 2019-06-17 |
| 1669949590 | Elizabeth Smith Dannewald | Nurse Practitioner | 625 E Broadway Ave, Jackson, WY 83001 | 2018-10-29 |
| 1528533973 | Hanna Kirsten | Occupational Therapy Assistant | 625 E Broadway Ave, Jackson, WY 83001-8642 | 2018-10-11 |
| 1891270500 | Jamie Loomis | Physical Therapy Assistant | 625 E Broadway Ave, Jackson, WY 83001-8642 | 2018-09-27 |
| 1942784806 | Jared Travis Martin | Physical Therapy Assistant | 625 E Broadway Ave, Jackson, WY 83001-8642 | 2018-09-17 |
| 1891274320 | Wendy Carbone | Physical Therapist | 625 E Broadway Ave, Jackson, WY 83001-8642 | 2018-08-07 |
| 1144732736 | 4js LLC | Registered Nurse | 625 E Broadway Ave, Jackson, WY 83001-8642 | 2017-11-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861006108 | Anne Kathleen Milburn | Physical Therapist | 3620 S Park Drive, Jackson, WY 83001 | 2020-09-03 |
| 1568009637 | Katherine Pringle Ford | Case Manager/Care Coordinator | 2065 E. Limber Pine Road, Jackson, WY 83001 | 2019-12-07 |
| 1043878408 | Cossette Burnham | Physical Therapist | Four Pines Physical Therapy, 1090 S Hwy 89, Jackson, WY 83001 | 2019-05-31 |
| 1982169371 | Cynthia Buck Huyffer | Social Worker | 755a Cache Creek Drive, Jackson, WY 83001 | 2019-02-10 |
| 1093281594 | Lara Cilo | Speech-Language Pathologist | 1300 W. Valley Springs Road, Jackson, WY 83001 | 2018-10-23 |
| 1740776202 | Teton Oral and Maxillofacial Surgery | Dentist | 1160 Alpine Ln Ste 1d, Jackson, WY 83001 | 2018-07-09 |
| 1437642055 | Anna Yanchek | Physical Therapist | 1090 Us- 89, Jackson Hole, WY 83001 | 2018-06-08 |
| 1891200762 | Tyler Ross Wright | Chiropractor | 1325 Us-89, Suite 108, Jackson, WY 83001 | 2017-12-13 |
| 1073027280 | Root To Rise Counseling and Consulting, Pllc | Social Worker | 2033 Dandelion Court, Jackson, WY 83001 | 2017-11-27 |
| 1962923912 | Piper Worthington | Social Worker | 1910 High School Rd, Jackson, WY 83001 | 2017-06-29 |
| Find all providers in zip 83001 | ||||
| Taxonomy Code | 207ZP0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. [7/1/2007: definition added, source added, 7/1/2009: defintion reformatted; 7/1/2011: modified source] - Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/. American Osteopathic Board of Pathology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology (note: this taxonomy code identifies the "anatomic pathology only" route). To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790989390 | Erin Ananda Barnhart | Pathology | 1700 E Woodrow Wilson Ave, Jackson, MS 39216-5121 | 2007-06-14 |
| 1467500173 | Frank X. Torres | Pathology | 2500 N State St, Jmm Room 2525, Jackson, MS 39216-4500 | 2007-01-08 |
| 1396776258 | Steven A Bigler | Pathology | 2500 North State Street, Jackson, MS 39202 | 2006-07-06 |
| 1205808342 | Federico Gonzalez-fernandez | Pathology | 2500 N State St, Jackson, MS 39216-4500 | 2006-02-03 |
| 1033117445 | Jack Roy Lewin | Pathology | 2500 N State St, Jackson, MS 39216-4500 | 2005-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740220953 | Karin Diane Berg | Pathology | 1441 Wilkins Cir, Casper, WY 82601-1337 | 2006-06-07 |
| 1912973330 | William B Woodward Jr. | Pathology | 501 S Burma Ave, Gillette, WY 82716-3426 | 2006-02-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.