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General NPI Number Information
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NPI Number | 1831150119
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Entity Type | Organization
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Legal Business Name | MEMORIAL HOSPITAL, INC.
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 210 MARIE LANGDON DR
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City | MANCHESTER
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State | KY
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Zip | 40962-6388
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Country | US
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Telephone | 606-598-5104
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Fax | 606-598-0983
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Provider Business Mailing Address
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Address Line | 210 MARIE LANGDON DR
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City | MANCHESTER
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State | KY
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Zip | 40962-6388
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Country | US
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Telephone | 606-598-5104
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SISSEL JACOB
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Credential |
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Telephone | 606-598-5104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | KY
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