Provider Demographics
NPI:1184765836
Name:MEMORIAL ENTERPRISES INC
Entity type:Organization
Organization Name:MEMORIAL ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR OF FINANCE AND CODING
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEUBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:717-815-2557
Mailing Address - Street 1:1420 6TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2620
Mailing Address - Country:US
Mailing Address - Phone:717-815-2557
Mailing Address - Fax:717-854-1434
Practice Address - Street 1:2295A N SUSQUEHANNA TRL
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-8495
Practice Address - Country:US
Practice Address - Phone:717-812-0731
Practice Address - Fax:717-812-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010092L207Q00000X
PAOS009643L207Q00000X
PAOS012217L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01960399Medicaid
PA01807995Medicaid
PA001867044Medicaid
PA054124N84Medicare ID - Type Unspecified
PA001867044Medicaid
PA01960399Medicaid
PA072323N84Medicare ID - Type Unspecified
PADA2803Medicare PIN
PA040554N84Medicare ID - Type Unspecified
PA01807995Medicaid