Healthcare Provider Details

I. General information

NPI: 1457592693
Provider Name (Legal Business Name): MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 MEMORIAL DR SUITE 2
MANCHESTER KY
40962-6195
US

IV. Provider business mailing address

509 MEMORIAL DR SUITE 2
MANCHESTER KY
40962-6195
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-8813
  • Fax: 606-598-0983
Mailing address:
  • Phone: 606-598-8813
  • Fax: 606-598-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BENNY NOLEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 606-598-5104