Provider Demographics
NPI:1881603850
Name:MEMORIAL COMMUNITY HEALTH, INC
Entity type:Organization
Organization Name:MEMORIAL COMMUNITY HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FENDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-694-6007
Mailing Address - Street 1:609 O ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-1100
Mailing Address - Country:US
Mailing Address - Phone:402-694-3191
Mailing Address - Fax:402-694-2146
Practice Address - Street 1:609 O ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-1100
Practice Address - Country:US
Practice Address - Phone:402-694-3191
Practice Address - Fax:402-694-2146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE086214Medicare ID - Type UnspecifiedMEDICARE NUMBER