Provider Demographics
NPI:1477790152
Name:LAWRENCE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:LAWRENCE GENERAL HOSPITAL
Other - Org Name:SPICKET CRNA SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE-PRESIDENT, FISCAL AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:FHFMA
Authorized Official - Phone:978-683-4000
Mailing Address - Street 1:38 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2819
Mailing Address - Country:US
Mailing Address - Phone:978-683-4000
Mailing Address - Fax:
Practice Address - Street 1:1 GENERAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2961
Practice Address - Country:US
Practice Address - Phone:978-683-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-16
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist AssistantGroup - Single Specialty