Provider Demographics
NPI:1598812992
Name:MEMORIAL ENTERPRISES INC
Entity Type:Organization
Organization Name:MEMORIAL ENTERPRISES INC
Other - Org Name:MEMORIAL PRIMARY CARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR FINANCE AND CODING
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEUBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:717-815-2557
Mailing Address - Street 1:1420 6TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2620
Mailing Address - Country:US
Mailing Address - Phone:717-815-2557
Mailing Address - Fax:717-854-1434
Practice Address - Street 1:72 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STEWARTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17363-4153
Practice Address - Country:US
Practice Address - Phone:717-993-2543
Practice Address - Fax:717-993-9258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005214L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00863283Medicaid
PA01090970Medicaid
PADA2803Medicare PIN
039846Medicare PIN
PA00863283Medicaid
PAF31580Medicare UPIN
PA01090970Medicaid
PA159278N84Medicare ID - Type Unspecified