Provider Demographics
NPI:1205139409
Name:MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PRACTICE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREMER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:989-729-4528
Mailing Address - Street 1:826 W KING ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2120
Mailing Address - Country:US
Mailing Address - Phone:989-723-5211
Mailing Address - Fax:989-723-9446
Practice Address - Street 1:9099 E LANSING RD
Practice Address - Street 2:STE A
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1083
Practice Address - Country:US
Practice Address - Phone:989-288-2651
Practice Address - Fax:989-288-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI238918Medicare Oscar/Certification