Provider Demographics
NPI:1154966778
Name:MEMBER MEDICAL, INC.
Entity type:Organization
Organization Name:MEMBER MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RINEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-307-1980
Mailing Address - Street 1:3046 DOLPHIN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7182
Mailing Address - Country:US
Mailing Address - Phone:270-307-1980
Mailing Address - Fax:270-505-4204
Practice Address - Street 1:3046 DOLPHIN DR STE 104
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7182
Practice Address - Country:US
Practice Address - Phone:270-307-1980
Practice Address - Fax:270-505-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care