Provider Demographics
NPI:1003936725
Name:MEMORIAL HOSPITAL AND MEDICAL CENTER OF CUMBERLAND INC
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL AND MEDICAL CENTER OF CUMBERLAND INC
Other - Org Name:MEMORIAL HOSPITAL ORTHOPAEDIC PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:REPAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-723-6414
Mailing Address - Street 1:600 MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3765
Mailing Address - Country:US
Mailing Address - Phone:301-723-4100
Mailing Address - Fax:301-723-1480
Practice Address - Street 1:600 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3765
Practice Address - Country:US
Practice Address - Phone:301-723-4100
Practice Address - Fax:301-723-1480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL AND MEDICAL CENTER OF CUMBERLAND, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-29
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0043316000Medicaid
MDKV04MEOtherBC BS
MDCH1651 CC2609OtherTRAVELERS MEDICARE
DCE458OtherFEDERAL BC BS
DCE458OtherFEDERAL BC BS