Provider Demographics
NPI:1598977787
Name:MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL
Other - Org Name:MEMORIAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER CODING & PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-723-5211
Mailing Address - Street 1:826 W KING ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867
Mailing Address - Country:US
Mailing Address - Phone:989-723-5211
Mailing Address - Fax:
Practice Address - Street 1:3337 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872
Practice Address - Country:US
Practice Address - Phone:517-625-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-03
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE7951OtherMEDICARE RR GROUP
MI113320228Medicaid
F57831Medicare UPIN
MI113320228Medicaid
CE7951OtherMEDICARE RR GROUP