Provider Demographics
NPI:1376510644
Name:MEMORIAL FAMILY CARE INC
Entity Type:Organization
Organization Name:MEMORIAL FAMILY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-792-3730
Mailing Address - Street 1:PO BOX 10399
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5007
Mailing Address - Country:US
Mailing Address - Phone:434-792-3730
Mailing Address - Fax:434-792-6048
Practice Address - Street 1:501 RISON ST
Practice Address - Street 2:SUITE 120
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2425
Practice Address - Country:US
Practice Address - Phone:434-792-3730
Practice Address - Fax:434-792-6048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-04
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89063VUOtherEDS NC MEDICAID
VA258015OtherANTHEM
VACL9316OtherPALMETTO GBA MEDICARE
VA005619505Medicaid
VA258015OtherANTHEM
VAC01226Medicare PIN