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General NPI Number Information
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NPI Number | 1801005210
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Entity Type | Organization
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Legal Business Name | MEMORIAL MEDICAL CENTER INC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | 1615 MAPLE LN
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City | ASHLAND
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State | WI
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Zip | 54806-3610
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Country | US
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Telephone | 715-685-5500
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Fax | 715-685-5118
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Provider Business Mailing Address
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Address Line | 1615 MAPLE LN
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City | ASHLAND
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State | WI
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Zip | 54806-3610
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Country | US
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Telephone | 715-685-5500
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Fax | 715-685-5118
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON T DOUGLAS
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Credential |
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Telephone | 715-685-5512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 275
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License Number State | WI
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