Provider Demographics
NPI:1801096730
Name:GREGG L LAWS MD
Entity type:Organization
Organization Name:GREGG L LAWS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-854-4552
Mailing Address - Street 1:1115 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1438
Mailing Address - Country:US
Mailing Address - Phone:217-854-4552
Mailing Address - Fax:217-854-5204
Practice Address - Street 1:1115 MORGAN ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1438
Practice Address - Country:US
Practice Address - Phone:217-854-4552
Practice Address - Fax:217-854-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
134799OtherHEALTHLINK
C43578OtherUPIN
IL9900567OtherBLUE CROSS BLUE SHIELD
134799OtherHEALTHLINK
IL=========001Medicaid
IL=========002Medicaid
134799OtherHEALTHLINK
IL9900567OtherBLUE CROSS BLUE SHIELD
IL148982Medicare PIN