Provider Demographics
NPI:1144531153
Name:LAWRENCE M. LINETT,M.D.,PLLC
Entity type:Organization
Organization Name:LAWRENCE M. LINETT,M.D.,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LINETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-392-1252
Mailing Address - Street 1:2595 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7748
Mailing Address - Country:US
Mailing Address - Phone:910-392-1252
Mailing Address - Fax:
Practice Address - Street 1:5311 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2211
Practice Address - Country:US
Practice Address - Phone:910-395-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29322261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910174Medicaid
NC8910174Medicaid