MEMORIAL HOSPITAL, INC. (NPI# 1649573692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649573692 |
| Entity Type | Organization |
| Organization Name | MEMORIAL HOSPITAL, INC. |
| Other Organization Name | PHYSICIAN SERVICES OF MEMORIAL HOSPITAL RADIOLOGY |
| Practice Address |
210 Marie Langdon Dr Manchester KY 40962-6388 |
| Mailing Address |
509 Memorial Dr Suite 2 Manchester KY 40962-6195 |
| Practice Telephone | 6065985104 |
| Practice Fax Number | 6065980983 |
| Mailing Telephone | 6065985104 |
| Mailing Fax Number | 6065980983 |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2011-02-24 |
| Authorized Official Name | BENNY NOLEN (VICE PRESIDENT) |
| Authorized Official Telephone | 6065985104 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 65934523 | 05 |
| Other Name | Type Code |
|---|---|
| Physician Services of Memorial Hospital Radiology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598782096 | Memorial Hospital, Inc. | Home Health | 705 C Street, Ceredo, WV 25507 | 2006-07-17 |
| 1891720348 | Memorial Hospital, Inc. | Home Health | 155 E 2nd Ave, Williamson, WV 25661-3601 | 2006-07-12 |
| 1902839293 | Memorial Hospital, Inc. | Home Health | 149 Health Care Ln, Jellico, TN 37762-4433 | 2006-07-09 |
| 1376532713 | Memorial Hospital, Inc. | Clinic/Center | 502 E Elm Dr, Loyal, WI 54446-9604 | 2005-10-18 |
| 1457999476 | Memorial Hospital, Inc. | Clinic/Center | 102 W Cannery St, Greenwood, WI 54437-9705 | 2019-12-20 |
| 1760020838 | Memorial Hospital, Inc. | Clinic/Center | 212800 Stainless Ave, Stratford, WI 54484-4325 | 2019-12-19 |
| 1780222844 | Memorial Hospital, Inc. | Clinic/Center | 111 Dehne Dr, Colby, WI 54421-9581 | 2019-12-19 |
| 1881112134 | Memorial Hospital, Inc. | Clinic/Center | 145 Orchard St, Oneida, KY 40972 | 2017-09-07 |
| 1902208267 | Memorial Hospital, Inc. | Pediatrics | 94 Marie Langdon Dr, Suite 1, Manchester, KY 40962-6353 | 2014-09-18 |
| 1962803460 | Memorial Hospital, Inc. | Clinic/Center | 65 Glenndale Rd, Suite 2, Manchester, KY 40962-6212 | 2014-09-16 |
| Street Address |
210 MARIE LANGDON DR |
| City | MANCHESTER |
| State | KY |
| Zip Code | 40962-6388 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770553463 | Anita F Cornett | Internal Medicine | 210 Marie Langdon Dr, Manchester, KY 40962-6388 | 2006-01-25 |
| 1134778475 | Alma Asher | Nurse Practitioner | 210 Marie Langdon Dr, Manchester, KY 40962-6388 | 2019-09-09 |
| 1821575002 | Tara Lee Griffitts | Nurse Practitioner | 210 Marie Langdon Dr, Manchester, KY 40962-6388 | 2018-07-20 |
| 1720586837 | Michael Shawn Ledford | Pharmacist | 210 Marie Langdon Dr, Manchester, KY 40962-6388 | 2018-01-24 |
| 1992203004 | Derrick Clinton Herron | Pharmacist | 210 Marie Langdon Dr, Manchester, KY 40962-6388 | 2018-01-24 |
| 1275974412 | Kayla Renee Marcum | Nurse Practitioner | 210 Marie Langdon Dr, Manchester, KY 40962-6388 | 2013-07-16 |
| 1588972673 | Zaman Shah | Hospitalist | 210 Marie Langdon Dr, Manchester, KY 40962-6388 | 2010-09-22 |
| 1326371287 | Tammy Lynn Hacker | Physical Therapy Assistant | 210 Marie Langdon Dr, Manchester, KY 40962-6388 | 2009-09-10 |
| 1205086097 | Michael Todd Brashear | Nurse Anesthetist, Certified Registered | 210 Marie Langdon Dr, Manchester, KY 40962-6388 | 2008-09-29 |
| 1699951558 | Kobkit Putrakul | Emergency Medicine | 210 Marie Langdon Dr, Manchester, KY 40962 | 2008-01-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609392356 | Angela Woods | Speech-Language Pathologist | 96 Woods Rd, Manchester, KY 40962 | 2017-08-15 |
| 1346627296 | Betty Alevras | Nurse Practitioner | 21 Crestview Drive, 204 Town Branch Road, Manchester, KY 40962 | 2015-04-29 |
| 1740525773 | Clay Community Pharmacy LLC | Pharmacy | 118 Clay Co S/c, Manchester, KY 40962 | 2012-12-03 |
| 1669758579 | Becky F Stubblefield | Nurse Practitioner | 65 Glenndale Drive, Manchester, KY 40962 | 2011-10-25 |
| 1891022315 | Sabrina Nicole Hacker | Occupational Therapist | 376 Manchester Square Shopping Centre, Manchester, KY 40962 | 2009-11-04 |
| 1114102167 | H&n Drug | Durable Medical Equipment & Medical Supplies | 515 Memorial Dr., Suite 2, Manchester, KY 40962 | 2008-01-08 |
| 1598944043 | Cumberland Valley Dist. Health Dept | Public Health or Welfare | 1983 Hwy 421, Manchester, KY 40962 | 2007-11-01 |
| 1023223203 | Dinah Lynn Sowders | Speech-Language Pathologist | 561 Mill Pond Drive, Manchester, KY 40962 | 2007-05-11 |
| 1104965300 | American Health Management, Inc. | Case Management | 2609 Hwy 80, Manchester, KY 40962 | 2007-02-05 |
| 1306902572 | Manchester Pharmacist Group LLC | Durable Medical Equipment & Medical Supplies | 415 Richmond Road, Unit B, Manchester, KY 40962 | 2006-12-29 |
| Find all providers in zip 40962 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932300225 | Francis Moors Bradley | Radiology | 11 Eaglehead Rd, Manchester, MA 01944-1550 | 2007-05-31 |
| 1902167885 | Carla Alexis De Venecia | Radiology | 185 Queen City Ave, Elliot Breast Health Center, Manchester, NH 03101-7121 | 2012-06-06 |
| 1932338571 | Steven E Kammann | Radiology | 100 Hitchcock Way, Manchester, NH 03104-4125 | 2009-07-02 |
| 1770769515 | Marta Maryam Redjaee | Radiology | 718 Smyth Rd, Manchester, NH 03104-7007 | 2008-01-10 |
| 1144404948 | Lara Bryan-rest | Radiology | 341 E Center St, #141, Manchester, CT 06040-4445 | 2007-12-28 |
| 1639379316 | Todd A. Noce | Radiology | 100 Hitchcock Way, Manchester, NH 03104-4125 | 2007-07-20 |
| 1548376007 | Jennifer A. Januario | Radiology | 718 Smyth Rd, Radiology, Manchester, NH 03104-7004 | 2006-08-21 |
| 1578573606 | Edward G Denstman | Radiology | 71 Haynes St, Manchester, CT 06040 | 2006-08-09 |
| 1730199878 | Thomas E Kilkenny | Radiology | 71 Haynes St, Manchester, CT 06040 | 2006-08-09 |
| 1912917055 | Deepak Bramhavar | Radiology | 71 Haynes St, Manchester, CT 06040 | 2006-08-09 |
| Find all providers in MANCHESTER | ||||
| City | MANCHESTER |
| Zip Code | 40962 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.