Provider Demographics
NPI:1811183692
Name:LAWRENCE COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:LAWRENCE COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROJECT COORD
Authorized Official - Prefix:
Authorized Official - First Name:JOSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-371-9756
Mailing Address - Street 1:2111 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-2085
Mailing Address - Country:US
Mailing Address - Phone:618-943-1000
Mailing Address - Fax:618-943-7219
Practice Address - Street 1:2111 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2085
Practice Address - Country:US
Practice Address - Phone:618-943-7216
Practice Address - Fax:618-943-7219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-14
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881643401OtherLCMH PART A NPI 1881643401 - 141344
IL141344Medicare PIN
1881643401OtherLCMH PART A NPI 1881643401 - 141344
IL143499Medicare Oscar/Certification