Provider Demographics
NPI:1578327896
Name:DOCTORS MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:DOCTORS MEMORIAL HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRAMBLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-584-0643
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-7306
Mailing Address - Country:US
Mailing Address - Phone:850-584-0643
Mailing Address - Fax:850-223-2308
Practice Address - Street 1:333 N BYRON BUTLER PKWY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2300
Practice Address - Country:US
Practice Address - Phone:850-584-0643
Practice Address - Fax:850-223-2308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health