Provider Demographics
NPI:1750696381
Name:MEMORIAL ENTERPRISES, INC.
Entity type:Organization
Organization Name:MEMORIAL ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER 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 1:3141 CAPE HORN RD
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9071
Mailing Address - Country:US
Mailing Address - Phone:717-815-2555
Mailing Address - Fax:717-854-1434
Practice Address - Street 1:3141 CAPE HORN RD
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-9071
Practice Address - Country:US
Practice Address - Phone:717-815-2555
Practice Address - Fax:717-854-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039846OtherGROUP PTAN