Provider Demographics
NPI:1669861530
Name:MEMORIAL HEALTH PARTNERS FOUNDATION, INC.
Entity Type:Organization
Organization Name:MEMORIAL HEALTH PARTNERS FOUNDATION, INC.
Other - Org Name:PROFESSIONAL PARK ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHYSICIAN OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-424-1551
Mailing Address - Street 1:611 E VILLANOW ST
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-2618
Mailing Address - Country:US
Mailing Address - Phone:706-638-1606
Mailing Address - Fax:706-638-9987
Practice Address - Street 1:611 E VILLANOW ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2618
Practice Address - Country:US
Practice Address - Phone:706-638-1606
Practice Address - Fax:706-638-9987
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HEALTH PARTNERS FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site