Provider Demographics
NPI:1194829580
Name:MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOW
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:912-350-8613
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-3719
Mailing Address - Fax:912-350-3948
Practice Address - Street 1:5002 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6226
Practice Address - Country:US
Practice Address - Phone:912-350-2324
Practice Address - Fax:912-350-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025-377273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA001216OtherBLUE CROSS BLUE SHIELD
GA10006521OtherMEDICAID CMO
SC117736Medicaid
GA00001273AMedicaid
SC456640Medicaid
GA486OtherMEDICAID CMO
FL091693500Medicaid
GA10006521OtherMEDICAID CMO
SC456640Medicaid