Memorial Hospital, Inc.
Organization Active NPI Emergency Medicine Physician · Manchester, KY
NPI 1366624488 · NPPES record last updated Jan 13, 2021
Key facts
- NPI
- 1366624488
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- MEMORIAL HOSPITAL, INC.
- Practice address
- 210 Marie Langdon Dr
Manchester, KY 40962-6388 - Phone
- (606) 598-5104
- Fax
- (606) 598-0983
- NPI assigned
- Nov 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Benny Nolen
- Title
- Vice President
- Phone
- (606) 598-5104
Other NPIs on the same Medicare enrollment 20
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041103001183 | KY | Part B Supplier - Clinic/Group Practice | 4486616141 |
Receives reassigned benefits from 129 practitioners 20 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Pineville, KY; Somerset, KY; Oneida, KY; MC Kee, KY; Manchester, KY; London, KY; Corbin, KY; Beverly, KY |
National Provider Directory
Locations
509 Memorial Dr
Ste 2
Manchester, KY 40962
Phone (606) 598-4384
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes |
Addresses
Primary practice location
210 Marie Langdon Dr
Manchester, KY 40962-6388
Mailing address
509 Memorial Dr
Suite 2
Manchester, KY 40962-6195
Phone (606) 598-5104
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65934523 | Medicaid | KY | |
| 78905007 | Medicaid | KY | |
| CC2941 | Other | RR MEDICARE |
Other names
- Manchester Emergency Department
Other providers in Manchester, KY
- Memorial Hospital
- Memorial Hospital
- Memorial Hospital Inc
- Memorial Hospital Inc.
- Memorial Hospital, Inc.
- Memorial Hospital, Inc.
- Memorial Hospital, Inc.
- Memorial Hospital, Inc.
- Memorial Hospital, Inc.
- Memorial Hospital, Inc.
All providers in Manchester, KY · Emergency Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.