Provider Demographics
NPI:1083499503
Name:MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SISSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-5104
Mailing Address - Street 1:11217 HIGHWAY 421 S
Mailing Address - Street 2:
Mailing Address - City:TYNER
Mailing Address - State:KY
Mailing Address - Zip Code:40486-8352
Mailing Address - Country:US
Mailing Address - Phone:606-598-5104
Mailing Address - Fax:606-712-1200
Practice Address - Street 1:12904 ROBERT L MADON BYP STE 2
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-8063
Practice Address - Country:US
Practice Address - Phone:606-598-4508
Practice Address - Fax:606-712-1200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health