Provider Demographics
NPI:1114040813
Name:MEMORIAL BILLING COMPANY
Entity type:Organization
Organization Name:MEMORIAL BILLING COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER CODING & PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-729-4528
Mailing Address - Street 1:1480 N M 52
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1235
Mailing Address - Country:US
Mailing Address - Phone:989-723-5211
Mailing Address - Fax:989-723-9446
Practice Address - Street 1:1480 N M52
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-723-5211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX IDENTIFICATION NUMBER
MI0P1400Medicare ID - Type Unspecified