Provider Demographics
NPI:1477184968
Name:MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL INC
Other - Org Name:ADVENTHEALTH LONDON PARKWAY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-5104
Mailing Address - Street 1:56 MARIE LANGDON DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6329
Mailing Address - Country:US
Mailing Address - Phone:606-598-5104
Mailing Address - Fax:606-712-1200
Practice Address - Street 1:102 PROFESSIONAL DR STE 2
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8857
Practice Address - Country:US
Practice Address - Phone:606-878-9611
Practice Address - Fax:606-878-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health