Provider Demographics
NPI:1275979031
Name:MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:MEMORIAL MEDICAL AUGUSTA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL PROJECTS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-357-6594
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-0160
Mailing Address - Country:US
Mailing Address - Phone:217-357-6512
Mailing Address - Fax:217-357-6544
Practice Address - Street 1:204 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:IL
Practice Address - Zip Code:62311-1228
Practice Address - Country:US
Practice Address - Phone:217-392-2108
Practice Address - Fax:217-392-2110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty