Healthcare Provider Details

I. General information

NPI: 1558530600
Provider Name (Legal Business Name): MEMORIAL HOSPITAL FLAGLER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MEMORIAL MEDICAL PKWY
PALM COAST FL
32164-5980
US

IV. Provider business mailing address

PO BOX 864623
ORLANDO FL
32886-4623
US

V. Phone/Fax

Practice location:
  • Phone: 386-586-2000
  • Fax: 386-586-4620
Mailing address:
  • Phone: 386-671-4519
  • Fax: 386-672-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK RATHBUN
Title or Position: CFO
Credential:
Phone: 386-586-4200