Healthcare Provider Details

I. General information

NPI: 1063426823
Provider Name (Legal Business Name): MEMORIAL HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MEMORIAL MEDICAL PKWY
DAYTONA BEACH FL
32117-5167
US

IV. Provider business mailing address

770 W GRANADA BLVD STE 203
ORMOND BEACH FL
32174-5179
US

V. Phone/Fax

Practice location:
  • Phone: 386-231-6000
  • Fax: 386-231-3342
Mailing address:
  • Phone: 386-231-4610
  • Fax: 386-231-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4201
License Number StateFL

VIII. Authorized Official

Name: CORY DOMAYER
Title or Position: CFO
Credential:
Phone: 386-231-3906