Provider Demographics
NPI:1780801233
Name:MEMORY CLINIC LLC
Entity type:Organization
Organization Name:MEMORY CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-439-6025
Mailing Address - Street 1:207 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3341
Mailing Address - Country:US
Mailing Address - Phone:828-439-6085
Mailing Address - Fax:828-437-8212
Practice Address - Street 1:207 QUEEN ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3341
Practice Address - Country:US
Practice Address - Phone:828-439-6085
Practice Address - Fax:828-438-8777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORY CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904290Medicaid
NC5904290Medicaid