Healthcare Provider Details

I. General information

NPI: 1922009620
Provider Name (Legal Business Name): MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S BELMONT ST
YORK PA
17403-2608
US

IV. Provider business mailing address

PO BOX 8823
LANCASTER PA
17604-8823
US

V. Phone/Fax

Practice location:
  • Phone: 717-849-5331
  • Fax:
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: SALLY DIXON
Title or Position: CEO
Credential:
Phone: 717-849-5331