Organization
MEMORIAL HOSPITAL, INC.
Active
Other names
Mountain Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENNY NOLEN (VICE PRESIDENT)
(606) 598-5104
Entity
Organization
Contact information
Practice address
94 MARIE LANGDON DR, MANCHESTER, KY 40962-6353
(606) 598-5104
(606) 598-6507
Mailing address
509 MEMORIAL DR, MANCHESTER, KY 40962-6195
(606) 598-5104
(606) 598-6507
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31001134
—
KY
01
—
CC2941
RAILROAD MEDICARE
KY
Enumeration date
04/30/2007
Last updated
01/13/2021
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