MEMORIAL HOSPITAL, INC. (NPI# 1902839293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902839293 |
| Entity Type | Organization |
| Organization Name | MEMORIAL HOSPITAL, INC. |
| Other Organization Name | SUNBELT HOMECARE |
| Practice Address |
149 Health Care Ln Jellico TN 37762-4433 |
| Practice Telephone | 4237842452 |
| Practice Fax Number | 4237841184 |
| Mailing Telephone | 4237841206 |
| Mailing Fax Number | 4237841136 |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2017-01-26 |
| Authorized Official Name | PAUL MERKLIN (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 6065981035 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEMORIAL HOSPITAL, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251E00000X | Home Health | 00000000-16 | TN | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | JOHN DEERE TENNCARE | 0447492 | 01 |
| TN | BLUECARE | 3075983 | 01 |
| TN | STERLING LIFE MCR | 0447492 | 01 |
| TN | BLUE CROSS BLUE SHIELD | 46166 | 01 |
| TN | PHP COMPANIES | 100020437 | 01 |
| TN | TENNCARE SELECT | 3075983 | 01 |
| TN | PACIFICARE MCR | 0447492 | 01 |
| TN | JOHN DEERE HEALTH | 0447492 | 01 |
| TN | FEDERAL BLACK LUNG | 087482900 | 01 |
| Other Name | Type Code |
|---|---|
| Sunbelt Homecare | 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 |
| 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 |
| 1598166092 | Memorial Hospital, Inc. | Family Medicine | 515 Memorial Dr, Manchester, KY 40962-9157 | 2014-09-16 |
| Street Address |
149 HEALTH CARE LN |
| City | JELLICO |
| State | TN |
| Zip Code | 37762-4433 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487068136 | Camm Care LLC | Nursing Care | 149 Health Care Ln, Jellico, TN 37762-4433 | 2014-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063992600 | Springs of Life | Psychologist | 185 Baker Street, Jellico, TN 37762 | 2018-08-14 |
| 1679666366 | Charles Henry Wilkens | Family Medicine | 131 Hospital Lane, Jellico, TN 37762 | 2006-10-02 |
| 1225096217 | Benjamin Wayne D'ooge | Emergency Medicine | 188 Hospital Lane, Jellico, TN 37762 | 2006-05-02 |
| 1770790065 | Dayspring Health Inc | Physician Assistant | 107 S Main St, Jellico, TN 37762 | 2007-05-17 |
| 1790856102 | Charles R Hayes | Nurse Anesthetist, Certified Registered | 188 Hospital Ln, Jellico, TN 37762 | 2006-11-10 |
| 1023022084 | Dayspring Health Inc | Obstetrics & Gynecology | 550 Sunset Trl, Jellico, TN 37762 | 2006-07-27 |
| 1174691315 | Family Drug Center Inc | Durable Medical Equipment & Medical Supplies | 248 S Main St, Jellico, TN 37762-2017 | 2006-12-04 |
| 1114442175 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 248 S Main St, Jellico, TN 37762-2017 | 2017-08-10 |
| 1598211401 | Jonathan Broyles | Pharmacist | 248 S Main St, Jellico, TN 37762-2017 | 2016-08-30 |
| 1184008005 | Rite Aid of Tennessee Inc | Durable Medical Equipment & Medical Supplies | 248 S Main St, Jellico, TN 37762-2017 | 2015-07-10 |
| Find all providers in zip 37762 | ||||
| Taxonomy Code | 251E00000X |
| Grouping | Agencies |
| Classification | Home Health |
| A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |
| Notes: Source: CFR42 Chapter IV Part 484, http://www.access.gpo.gov/nara/cfr/waisidx_99/42cfr484_99.html [7/1/2007: definition added, source added] |
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| 1699393876 | Quality Assurance LLC | Home Health | 1565 Chariot Ln, Knoxville, TN 37918-6768 | 2020-07-14 |
| 1588282560 | Christacare, LLC | Home Health | 195 Chicken Pike, Smyrna, TN 37167-5059 | 2020-07-07 |
| 1437775053 | Prestige In Home Health Care | Home Health | 3355 Poplar Ave Ste 305, Memphis, TN 38111-4677 | 2020-06-19 |
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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.