Provider Demographics
NPI:1083778633
Name:MEMORIAL HEALTH CARE SYSTEM INC.
Entity Type:Organization
Organization Name:MEMORIAL HEALTH CARE SYSTEM INC.
Other - Org Name:MEMORIAL HOSPITAL HIXSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-495-8488
Mailing Address - Street 1:2051 HAMILL RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-6614
Mailing Address - Country:US
Mailing Address - Phone:423-495-7100
Mailing Address - Fax:423-495-6312
Practice Address - Street 1:2051 HAMILL RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-6614
Practice Address - Country:US
Practice Address - Phone:423-495-7100
Practice Address - Fax:423-495-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000071282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00236662AMedicaid
TN0440091Medicaid
TN440091Medicare Oscar/Certification
TN0440091Medicaid