Healthcare Provider Details

I. General information

NPI: 1891720348
Provider Name (Legal Business Name): MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E 2ND AVE
WILLIAMSON WV
25661-3601
US

IV. Provider business mailing address

PO BOX 445
WILLIAMSON WV
25661-0445
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-3010
  • Fax: 304-235-3014
Mailing address:
  • Phone: 304-235-3010
  • Fax: 304-235-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150039
License Number StateKY

VIII. Authorized Official

Name: RICHARD BOGGESS
Title or Position: CFO
Credential:
Phone: 606-598-5104