Healthcare Provider Details

I. General information

NPI: 1104443654
Provider Name (Legal Business Name): MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 QUEENDALE CTR STE 200
BEVERLY KY
40913-9608
US

IV. Provider business mailing address

53 QUEENDALE CTR STE 200
BEVERLY KY
40913-9608
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-4525
  • Fax: 606-599-2549
Mailing address:
  • Phone: 606-598-4525
  • Fax: 606-599-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER SELF
Title or Position: CEO
Credential:
Phone: 606-598-5104