NPIMap

Organization Active NPI

Memorial Hospital, Inc.

Doing business as Clay County Primary Care Center

  • Family Medicine Physician
  • Manchester, KY
National Provider Identifier
1457592693
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEMORIAL HOSPITAL, INC.
Doing business as
Clay County Primary Care Center
Practice address
509 Memorial Dr
Suite 2
Manchester, KY 40962-6195
Phone
(606) 598-8813
Fax
(606) 598-0983
NPI assigned
Mar 18, 2009
Last updated
Jan 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Benny Nolen
Title
Vice President
Phone
(606) 598-5104

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

Primary practice location

509 Memorial Dr
Suite 2
Manchester, KY 40962-6195

Mailing address

509 Memorial Dr
Suite 2
Manchester, KY 40962-6195
Phone (606) 598-8813

Other identifiers 2

IdentifierTypeStateIssuer
31001134MedicaidKY
CC2941OtherRR MEDICARE

Other names 1

  • Clay County Primary Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610496000000",
    "number": "1457592693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 MEMORIAL DR",
            "address_2": "SUITE 2",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409626195",
            "telephone_number": "606-598-8813",
            "fax_number": "606-598-0983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 MEMORIAL DR",
            "address_2": "SUITE 2",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409626195",
            "telephone_number": "606-598-8813",
            "fax_number": "606-598-0983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-18",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "NOLEN",
        "authorized_official_first_name": "BENNY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "606-598-5104",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31001134",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CC2941",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clay County Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clay County Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manchester, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.