Provider Demographics
NPI:1689996407
Name:MEMORIAL ENTERPRISES INC. D/B/A MEMORIAL PRIMARY CARE
Entity Type:Organization
Organization Name:MEMORIAL ENTERPRISES INC. D/B/A MEMORIAL PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF FINANCE AND CODING
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NEUBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-843-1420
Mailing Address - Street 1:1412 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2648
Mailing Address - Country:US
Mailing Address - Phone:717-845-8173
Mailing Address - Fax:717-854-1434
Practice Address - Street 1:1232 GREENSPRINGS DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8825
Practice Address - Country:US
Practice Address - Phone:717-755-6166
Practice Address - Fax:717-755-1591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-20
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOSO14851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty