Provider Demographics
NPI:1265226120
Name:COMMUNITY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE OPTIMIZATION
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-828-5009
Mailing Address - Street 1:PO BOX 787755
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7755
Mailing Address - Country:US
Mailing Address - Phone:804-828-5009
Mailing Address - Fax:
Practice Address - Street 1:1755 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-4080
Practice Address - Country:US
Practice Address - Phone:804-828-5009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49D2305512OtherCMS CLIA