Healthcare Provider Details

I. General information

NPI: 1023649514
Provider Name (Legal Business Name): MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 05/17/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 MAIN ST S
MCKEE KY
40447-7081
US

IV. Provider business mailing address

56 MARIE LANGDON DR
MANCHESTER KY
40962-6329
US

V. Phone/Fax

Practice location:
  • Phone: 606-287-3444
  • Fax: 606-287-3445
Mailing address:
  • Phone: 606-598-5104
  • Fax: 606-598-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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