| Memorial Hospital, Inc. | |
| 53 Queendale Ctr Ste 2 Beverly KY 40913-8621 | |
| (606) 598-5135 | |
| (606) 599-2525 | 
| Full Name | Memorial Hospital, Inc. | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 53 Queendale Ctr Ste 2, Beverly, Kentucky | 
| Authorized Official Name and Position | Sissel Jacob (CEO) | 
| Authorized Official Contact | 6065985104 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Memorial Hospital, Inc. 210 Marie Langdon Dr Manchester KY 40962-6388 Ph: (606) 598-5104 | Memorial Hospital, Inc. 53 Queendale Ctr Ste 2 Beverly KY 40913-8621 Ph: (606) 598-5135 | 
| NPI Number | 1558665752 | 
|---|---|
| Provider Enumeration Date | 01/03/2011 | 
| Last Update Date | 02/09/2023 | 
| Medicare PECOS PAC ID | 4486616141 | 
|---|---|
| Medicare Enrollment ID | O20130620000577 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1558665752 | NPI | - | NPPES | 
| 7100312760 | Medicaid | KY | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary | 
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |