1760632780 NPI number — MEMORIAL HEALTH PARTNERS FOUNDATION INC

Table of content: (NPI 1760632780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760632780 NPI number — MEMORIAL HEALTH PARTNERS FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL HEALTH PARTNERS FOUNDATION 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:
CHI MEMORIAL FAMILY PRACTICE ASSOCIATES - LAFAYETTE
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:
1760632780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 749748
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-9748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-495-8659
Provider Business Mailing Address Fax Number:
423-495-4970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 E VILLANOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA FAYETTE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30728-2618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-638-1606
Provider Business Practice Location Address Fax Number:
706-638-9987
Provider Enumeration Date:
09/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
MAELOR
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-495-8659

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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