Provider Demographics
NPI:1669437216
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:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VP/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:REPAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-723-6414
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:301-723-4000
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:301-723-4000
Practice Address - Fax:301-723-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01-006282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD217125OtherALLIANCE MAMSI MDIPA OPC
MDMB4OtherBLUE CHOICE FEDERAL
WV0001768000Medicaid
PA1007410690004Medicaid
MD59010201OtherBLUE CROSS
=========OtherTRICARE
MD217125OtherALLIANCE MAMSI MDIPA OPC
PA1007410690004Medicaid
MD212302Medicare Oscar/Certification