1700092459 NPI number — LAWRENCE AND MEMORIAL HOSPITAL, INC.

Table of content: (NPI 1700092459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700092459 NPI number — LAWRENCE AND MEMORIAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE AND MEMORIAL HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAWRENCE AND MEMORIAL HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700092459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
365 MONTAUK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW LONDON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06320-4700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-442-0711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
365 MONTAUK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LONDON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06320-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-442-0711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MESSINA
Authorized Official First Name:
MARY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
SR. REIMBURSEMENT MANAGER
Authorized Official Telephone Number:
203-688-8543

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0047 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004041679 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7002688 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7201672 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 97000007 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP31514 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 033921 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 538520200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP41514 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9127 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 092591800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 946704 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: H04961 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004024972 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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