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NPI Code Detail

MEDICARE: MEMORIAL ENTERPRISES, INC.

MEDICARE: MEMORIAL ENTERPRISES, 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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1039846OTHERPAGROUP PTAN

General Provider Information

NPI Number : 1750696381
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMORIAL ENTERPRISES, INC.
Provider Business Mailing Address
First Line : 3141 CAPE HORN RD
Second Line :
City : RED LION
State : PA
Zip : 17356-9071
Country : US
Telephone Number : 717-815-2555
Fax Number : 717-854-1434
Provider Business Practice Location Address
First Line : 3141 CAPE HORN RD
Second Line :
City : RED LION
State : PA
Zip : 17356-9071
Country : US
Telephone Number : 717-815-2555
Fax Number : 717-854-1434
Authorized Official
Title or Position : MANAGER OF FINANCE AND CODING
Name : MS. LINDA A NEUBAUER
Credential : CPC
Telephone Number : 717-815-2557
Provider Enumeration Date : 08/06/2010
Last Update Date : 06/10/2011

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Directions to “MEMORIAL ENTERPRISES, INC. ” Practice Location

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