Healthcare Provider Details

I. General information

NPI: 1033510961
Provider Name (Legal Business Name): MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 GLENNDALE RD SUITE 1
MANCHESTER KY
40962-6212
US

IV. Provider business mailing address

509 MEMORIAL DR SUITE 2
MANCHESTER KY
40962-6195
US

V. Phone/Fax

Practice location:
  • Phone: 606-599-2508
  • Fax:
Mailing address:
  • Phone: 606-598-5104
  • Fax: 606-598-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CONNIE FARMER
Title or Position: BILLING MANAGER
Credential:
Phone: 606-598-5104