Provider Demographics
NPI:1902839293
Name:MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL, INC.
Other - Org Name:SUNBELT HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-1035
Mailing Address - Street 1:149 HEALTH CARE LN
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-4433
Mailing Address - Country:US
Mailing Address - Phone:423-784-1206
Mailing Address - Fax:423-784-1136
Practice Address - Street 1:149 HEALTH CARE LN
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-4433
Practice Address - Country:US
Practice Address - Phone:423-784-2452
Practice Address - Fax:423-784-1184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000000-16251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0447492OtherJOHN DEERE HEALTH
TN100020437OtherPHP COMPANIES
TN46166OtherBLUE CROSS BLUE SHIELD
TN0447492OtherPACIFICARE MCR
TN3075983OtherBLUECARE
TN3075983OtherTENNCARE SELECT
TN0447492OtherSTERLING LIFE MCR
TN0447492OtherJOHN DEERE TENNCARE
TN087482900OtherFEDERAL BLACK LUNG
TN3075983OtherTENNCARE SELECT