Provider Demographics
NPI:1790829430
Name:MEMORIAL HOSPITAL AND MEDICAL CENTER OF CUMBERLAND, INC.
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL AND MEDICAL CENTER OF CUMBERLAND, INC.
Other - Org Name:MEMORIAL HOSP DIAG SVCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBELEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:REPAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-723-1443
Mailing Address - Street 1:600 MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3765
Mailing Address - Country:US
Mailing Address - Phone:301-723-1443
Mailing Address - Fax:301-723-1480
Practice Address - Street 1:600 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3765
Practice Address - Country:US
Practice Address - Phone:301-723-1443
Practice Address - Fax:301-723-1480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPTIAL AND MEDICAL CENTER OF CUMBERLAND INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000176800Medicaid
MD000295000Medicaid
MD210025Medicare Oscar/Certification