Provider Demographics
NPI:1104443654
Name:MEMORIAL HOSPITAL INC
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-598-5104
Mailing Address - Street 1:53 QUEENDALE CTR STE 200
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:KY
Mailing Address - Zip Code:40913-9608
Mailing Address - Country:US
Mailing Address - Phone:606-598-4525
Mailing Address - Fax:606-599-2549
Practice Address - Street 1:53 QUEENDALE CTR STE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:KY
Practice Address - Zip Code:40913-9608
Practice Address - Country:US
Practice Address - Phone:606-598-4525
Practice Address - Fax:606-599-2549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTHEALTH SUNBELT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-01
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural