Provider Demographics
NPI:1922514744
Name:LAWRENCE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:LAWRENCE GENERAL HOSPITAL
Other - Org Name:LAWRENCE GENERAL HOSPITAL IMAGING-METHUEN
Other - Org Type:Other Name
Authorized Official - Title/Position:EXEC. VP
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-946-8093
Mailing Address - Street 1:1 GENERAL ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2961
Mailing Address - Country:US
Mailing Address - Phone:978-683-4000
Mailing Address - Fax:978-946-8137
Practice Address - Street 1:147 PELHAM ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-2060
Practice Address - Country:US
Practice Address - Phone:978-946-8425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2099261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026771Medicaid