1699088120 NPI number — MEMORIAL ENTERPRISES, INC.

Table of content: (NPI 1699088120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699088120 NPI number — MEMORIAL ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL ENTERPRISES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
YORK UROLOGY SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699088120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 6TH AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17403-2626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-815-2562
Provider Business Mailing Address Fax Number:
717-815-2563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 6TH AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17403-2626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-815-2562
Provider Business Practice Location Address Fax Number:
717-815-2563
Provider Enumeration Date:
07/26/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEUBAUER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER OF FINANCE AND CODING
Authorized Official Telephone Number:
717-815-2557

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  MD0703689L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 039846 . This is a "GROUP PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".