OrganizationMemorial Hospital, Inc.(Adventhealth Wound Care At Manchester)Family MedicineAllopathic & Osteopathic PhysiciansPractice Address515 Memorial Dr Ste 1, Manchester, KY 40962-9157(606) 598-4524(606) 598-5104PECOS EnrollmentBased on the most recent information from CMS, provider Memorial Hospital, Inc. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:36 AM.Profile DetailsProvider ID1912137720Provider TypeOrganizationFull NameMemorial Hospital, Inc.Other NameAdventhealth Wound Care At ManchesterSubpartNoEnumeration Date7/15/2009Last Updated2/9/2023Contact InformationPractice LocationPractice Address515 Memorial Dr Ste 1, Manchester, KY 40962-9157Phone(606) 598-4524Fax(606) 599-2554Mailing LocationMailing Address210 Marie Langdon Dr, Manchester, KY 40962-6388Phone(606) 598-5104FaxUnlisted FaxAuthorized OfficialNameJacob, Sissel (Ceo)Phone(606) 598-5104Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode208000000XDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID78905007DescriptionMedicaidIssuerUnlistedKentuckyID65934523DescriptionMedicaidIssuerUnlistedKentucky