Provider Demographics
NPI:1811922347
Name:MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-5104
Mailing Address - Street 1:210 MARIE LANGDON DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6388
Mailing Address - Country:US
Mailing Address - Phone:606-598-5104
Mailing Address - Fax:606-598-7008
Practice Address - Street 1:210 MARIE LANGDON DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6388
Practice Address - Country:US
Practice Address - Phone:606-598-1002
Practice Address - Fax:606-598-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100075282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5000038OtherUNITED HEALTHCARE
KY65265OtherMEMORIAL EMPLOYEES
IN100033950AOtherINDIANA MEDICAID
KY6280695OtherAETNA
KY30523000OtherBLACK LUNG
OH87696OtherOHIO MEDICAID
KY902088800OtherMEDICAID
KY1004431Medicaid
KY65265OtherANTHEM BLUE CROSS
KY180043OtherMEDICARE MANAGED CARE
KY1004431Medicaid
KY30523000OtherBLACK LUNG
KY5000038OtherUNITED HEALTHCARE
KY6280695OtherAETNA