1902839293 NPI number — MEMORIAL HOSPITAL, INC.

Table of content: (NPI 1902839293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902839293 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:
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:
1902839293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 HEALTH CARE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JELLICO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37762-4433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-784-1206
Provider Business Mailing Address Fax Number:
423-784-1136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149 HEALTH CARE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JELLICO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37762-4433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-784-2452
Provider Business Practice Location Address Fax Number:
423-784-1184
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MERKLIN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
606-598-1035

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  00000000-16 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0447492 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100020437 . This is a "PHP COMPANIES" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 46166 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0447492 . This is a "PACIFICARE MCR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3075983 . This is a "BLUECARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3075983 . This is a "TENNCARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0447492 . This is a "STERLING LIFE MCR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0447492 . This is a "JOHN DEERE TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 087482900 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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