Provider Demographics
NPI:1386101566
Name:THE MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:THE MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JORRI
Authorized Official - Middle Name:M
Authorized Official - Last Name:TREMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-729-4466
Mailing Address - Street 1:819 N SHIAWASSEE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1601
Mailing Address - Country:US
Mailing Address - Phone:989-729-4781
Mailing Address - Fax:989-729-4971
Practice Address - Street 1:9900 W M 21 STE 103
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:MI
Practice Address - Zip Code:48866-9798
Practice Address - Country:US
Practice Address - Phone:989-862-4858
Practice Address - Fax:989-862-5355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-25
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1386101566Medicaid