Provider Demographics
NPI:1619272770
Name:UNDERWOOD-MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:UNDERWOOD-MEMORIAL HOSPITAL
Other - Org Name:UNDERWOOD-MEMORIAL HOSPITAL BREAST CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. VP, CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:EXEC VP, COO
Authorized Official - Phone:856-845-0100
Mailing Address - Street 1:509 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1617
Mailing Address - Country:US
Mailing Address - Phone:856-845-0100
Mailing Address - Fax:
Practice Address - Street 1:155 BRIDGETON PIKE
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2669
Practice Address - Country:US
Practice Address - Phone:856-845-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNDERWOOD-MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty