1669437216 NPI number — MEMORIAL HOSPITAL AND MEDICAL CENTER OF CUMBERLAND, INC.

Table of content: (NPI 1669437216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669437216 NPI number — MEMORIAL HOSPITAL AND MEDICAL CENTER OF CUMBERLAND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL HOSPITAL AND MEDICAL CENTER OF CUMBERLAND, 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:
Provider Other Organization Name Type Code:
6
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:
1669437216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MEMORIAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMBERLAND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21502-3765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-723-4000
Provider Business Mailing Address Fax Number:
301-723-1480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MEMORIAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-3765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-723-4000
Provider Business Practice Location Address Fax Number:
301-723-1480
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REPAC
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SR. VP/CFO
Authorized Official Telephone Number:
301-723-6414

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  01-006 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 217125 . This is a "ALLIANCE MAMSI MDIPA OPC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MB4 . This is a "BLUE CHOICE FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0001768000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007410690004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 59010201 . This is a "BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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