Healthcare Provider Details

I. General information

NPI: 1114040813
Provider Name (Legal Business Name): MEMORIAL BILLING COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 N M52
OWOSSO MI
48867
US

IV. Provider business mailing address

1480 N M 52
OWOSSO MI
48867-1235
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-5211
  • Fax:
Mailing address:
  • Phone: 989-723-5211
  • Fax: 989-723-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOYCE BREMER
Title or Position: MANAGER CODING & PATIENT ACCOUNTS
Credential:
Phone: 989-729-4528