Provider Demographics
NPI:1073530879
Name:LAWRENCE AND MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:LAWRENCE AND MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR. INTEGRATED RECEIVABLES MGMT.
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WRINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-688-8411
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:2006-07-16
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207Q00000X, 207R00000X, 208000000X, 208M00000X, 363A00000X, 363AM0700X, 363L00000X
CT0047282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008OtherCT BLUE CROSS
MA7002688Medicaid
946704OtherCONNECTICARE
FL092591800Medicaid
MN538520200Medicaid
NC97000007Medicaid
9127OtherAETNA
H04961OtherOXFORD
CAXHSP41514Medicaid
CT004024972Medicaid
033921OtherHEALTHNET
MA7201672Medicaid
CT004041679Medicaid
CAXHSP31514Medicaid
CT008OtherCT BLUE CROSS
MA7002688Medicaid
CTC00007Medicare ID - Type Unspecified
070007Medicare ID - Type Unspecified