Provider Demographics
NPI:1780748871
Name:LAWRENCE AND MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:LAWRENCE AND MEMORIAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
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:2006-12-21
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0047273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7002688Medicaid
H04961OtherOXFORD
CT004041679Medicaid
FL092591800Medicaid
CT004024972Medicaid
CT008OtherBLUE CROSS
NC97000007Medicaid
CAXHSP41514Medicaid
9127OtherAETNA
CAXHSP31514Medicaid
MN538520200Medicaid
033921OtherHEALTHNET
MA7201672Medicaid
946704OtherCONNECTICARE
NC97000007Medicaid
CAXHSP41514Medicaid
CT004024972Medicaid
NC97000007Medicaid