Active NPI
Memorial Hospital
- Orthopaedic Surgery Physician
- Manchester, KY
National Provider Identifier
1982802468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 02508
- Legal business name
- MEMORIAL HOSPITAL
- Practice address
- 120 Marie Langdon Dr
Suite 2
Manchester, KY 40962-6352 - Phone
- (606) 598-4529
- Fax
- (606) 599-2529
- NPI assigned
- Jul 6, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Eric Lunde
- Title
- Vice President
- Phone
- (606) 598-5104
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 02508 | KY | Primary |
Addresses
Primary practice location
120 Marie Langdon Dr
Suite 2
Manchester, KY 40962-6352
Mailing address
509 Memorial Dr
Suite 2
Manchester, KY 40962-6195
Phone (606) 598-5104
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65934523 | Medicaid | KY |
Other names 1
- Manchester Orthopedic and Spine Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| 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 |
Other NPIs on the same Medicare enrollment 20
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183680000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1610496000000",
"number": "1982802468",
"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": "606-598-5104",
"fax_number": "606-598-0983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 MARIE LANGDON DR",
"address_2": "SUITE 2",
"city": "MANCHESTER",
"state": "KY",
"postal_code": "409626352",
"telephone_number": "606-598-4529",
"fax_number": "606-599-2529"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEMORIAL HOSPITAL",
"organizational_subpart": "NO",
"enumeration_date": "2007-07-06",
"last_updated": "2021-01-13",
"certification_date": "2021-01-13",
"status": "A",
"authorized_official_last_name": "LUNDE",
"authorized_official_first_name": "ERIC",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "606-598-5104",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": "KY",
"license": "02508",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "65934523",
"state": "KY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Manchester Orthopedic and Spine Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Manchester Orthopedic and Spine 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.