Provider Demographics
NPI:1699088120
Name:MEMORIAL ENTERPRISES, INC.
Entity type:Organization
Organization Name:MEMORIAL ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF FINANCE AND CODING
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEUBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-815-2557
Mailing Address - Street 1:1600 6TH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2626
Mailing Address - Country:US
Mailing Address - Phone:717-815-2562
Mailing Address - Fax:717-815-2563
Practice Address - Street 1:1600 6TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2626
Practice Address - Country:US
Practice Address - Phone:717-815-2562
Practice Address - Fax:717-815-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0703689L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039846OtherGROUP PTAN