Provider Demographics
NPI:1841339827
Name:MEMORIAL ENTERPRISES INC
Entity type:Organization
Organization Name:MEMORIAL ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR 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 1:1420 6TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2620
Mailing Address - Country:US
Mailing Address - Phone:717-815-2557
Mailing Address - Fax:717-854-1434
Practice Address - Street 1:55 OLD FARM LN
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1711
Practice Address - Country:US
Practice Address - Phone:717-235-4893
Practice Address - Fax:717-227-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032147E207Q00000X
PAOS010705L207Q00000X
PAOS004873L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001713217Medicaid
PA000908062Medicaid
PA001899137Medicaid
PA000908062Medicaid
PA001899137Medicaid
PAE13903Medicare UPIN
PAH62922Medicare UPIN
PADA2803Medicare PIN
PA058526N84Medicare ID - Type Unspecified
PA073672N84Medicare ID - Type Unspecified