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General NPI Number Information
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NPI Number | 1598860108
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Entity Type | Organization
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Legal Business Name | MEMORIAL HEALTH SYSTEMS INC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 301 MEMORIAL MEDICAL PKWY
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5167
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Country | US
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Telephone | 386-231-6000
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Fax | 386-231-1298
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Provider Business Mailing Address
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Address Line | 770 W GRANADA BLVD STE 203
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5179
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Country | US
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Telephone | 386-231-4610
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Fax | 386-231-1298
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Authorized Official
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Title or Position | CFO
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Name | CORY DOMAYER
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Credential |
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Telephone | 386-231-3906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 4201
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License Number State | FL
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