Healthcare Provider Details

I. General information

NPI: 1184765836
Provider Name (Legal Business Name): MEMORIAL ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295A N SUSQUEHANNA TRL
YORK PA
17404-8495
US

IV. Provider business mailing address

1420 6TH AVE SUITE 4
YORK PA
17403-2620
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-0731
  • Fax: 717-812-9848
Mailing address:
  • Phone: 717-815-2557
  • Fax: 717-854-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS010092L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS009643L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS012217L
License Number StatePA

VIII. Authorized Official

Name: MS. LINDA A NEUBAUER
Title or Position: MGR OF FINANCE AND CODING
Credential: CPC
Phone: 717-815-2557