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1255471827

NPI Code Detail

MEDICARE: MEMORIAL HOSPITAL INC.

MEDICARE: MEMORIAL HOSPITAL INC.

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
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	207V00000X	Obstetrics & Gynecology Physician		KY
4	208000000X	Pediatrics Physician		KY
5	363LF0000X	Family Nurse Practitioner
6	261QR1300X	Rural Health Clinic/Center	900236	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CC2941	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255471827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HOSPITAL INC.

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	:

Provider Business Practice Location Address
First Line	:	56 MARIE LANGDON DR
Second Line	:
City	:	MANCHESTER
State	:	KY
Zip	:	40962-6329
Country	:	US
Telephone Number	:	606-598-5104
Fax Number	:	606-598-1688

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. SISSEL JACOB
Credential	:
Telephone Number	:	606-598-5104

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	02/09/2023

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Directions to “MEMORIAL HOSPITAL INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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