1194744664 NPI number — MEMORIAL HOSPITAL INC

Table of content: (NPI 1194744664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194744664 NPI number — MEMORIAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL HOSPITAL 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:
MEMORIAL HOSPITAL HOME HEALTH
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:
1194744664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 MARIE LANGDON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40962-6388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-598-1969
Provider Business Mailing Address Fax Number:
606-598-2062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94 MARIE LANGDON DR STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962-6345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-598-1969
Provider Business Practice Location Address Fax Number:
606-598-2062
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KLEVEN
Authorized Official First Name:
JESSE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
606-598-1081

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  150039 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000054585 . This is a "BLUE CROSS BLUE SHIELD KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5000038 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65265 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 30523000 . This is a "BLACK LUNG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: A87696 . This is a "MEDICAID OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0005154214 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 001703971 . This is a "BLUE CROSS BLUE SHIELD WV" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 100033950A . This is a "INDIANA MEDICAID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1004431 . This is a "MEDICAID TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100443100 . This is a "MEDICAID PENDING" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 34002808 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180043 . This is a "MEDICARE MANAGED CARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4200280 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65265 . This is a "MEMORIAL EMPLOYEES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1038912 . This is a "BRICK STREET MTL WV WC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 100443100 . This is a "PASSPOST HEALTH PLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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