Provider Demographics
NPI:1073530879
Name:LAWRENCE AND MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:LAWRENCE AND MEMORIAL HOSPITAL, INC.
Other - Org Name:LAWRENCE AND MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR REGULATORY REIMBURSEMENT MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MESSINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-688-8543
Mailing Address - Street 1:365 MONTAUK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320
Mailing Address - Country:US
Mailing Address - Phone:860-442-0711
Mailing Address - Fax:
Practice Address - Street 1:365 MONTAUK AVENUE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-442-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0047282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7201672Medicaid
9127OtherAETNA
033921OtherHEALTHNET
946704OtherCONNECTICARE
H04961OtherOXFORD
CT008OtherCT BLUE CROSS
MN538520200Medicaid
CT004024972Medicaid
CT004041679Medicaid
MA7002688Medicaid
NC97000007Medicaid
CAXHSP41514Medicaid
FL092591800Medicaid
CAXHSP31514Medicaid
CT008OtherCT BLUE CROSS
MA7002688Medicaid
CTC00007Medicare ID - Type Unspecified
070007Medicare ID - Type Unspecified