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General NPI Number Information
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NPI Number | 1730469610
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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 | 08/23/2011
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 301 MEMORIAL MEDICAL PKWY HCP RAD
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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 | 386-671-4500
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Fax | 386-615-4103
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Provider Business Mailing Address
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Address Line | PO BOX 864627
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City | ORLANDO
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State | FL
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Zip | 32886-0001
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Country | US
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Telephone | 386-671-4500
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Fax | 386-615-4103
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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