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NPI Code Detail

MEDICARE: MEMORIAL HOSPITAL

MEDICARE: MEMORIAL HOSPITAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician900134KY

General Provider Information

NPI Number : 1245370824
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMORIAL HOSPITAL
Provider Business Mailing Address
First Line : 210 MARIE LANGDON DR
Second Line :
City : MANCHESTER
State : KY
Zip : 40962-6388
Country : US
Telephone Number : 606-598-5104
Fax Number : 606-599-0983
Provider Business Practice Location Address
First Line : 210 MARIE LANGDON DR
Second Line :
City : MANCHESTER
State : KY
Zip : 40962-6388
Country : US
Telephone Number : 606-598-5104
Fax Number : 606-599-0983
Authorized Official
Title or Position : VICE PRESIDENT
Name : MR. BENNY NOLEN
Credential :
Telephone Number : 606-598-5104
Provider Enumeration Date : 02/06/2007
Last Update Date : 01/13/2021

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Directions to “MEMORIAL HOSPITAL ” Practice Location

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