Organization
MEMORIAL HOSPITAL INC.
Active
Other names
AdventHealth Manchester
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SISSEL JACOB (PRESIDENT/CEO)
(606) 598-5104
Entity
Organization
Contact information
Practice address
56 MARIE LANGDON DR, MANCHESTER, KY 40962-6329
(606) 598-5104
(606) 598-1688
Mailing address
210 MARIE LANGDON DR, MANCHESTER, KY 40962-6388
(606) 598-5104
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
KY
208000000X
Pediatrics Physician
—
KY
261QR1300X
Rural Health Clinic/Center
Primary
900236
KY
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31001134
—
KY
05
—
7100339170
—
KY
01
—
CC2941
RR MEDICARE
—
Enumeration date
02/06/2007
Last updated
02/09/2023
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