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General NPI Number Information
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NPI Number | 1851348429
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Entity Type | Organization
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Legal Business Name | MEMORIAL HEALTHCARE GROUP, INC.
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 4901 RICHARD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32207-7328
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Country | US
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Telephone | 904-737-3120
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Fax | 904-730-5991
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Provider Business Mailing Address
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Address Line | 4901 RICHARD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32207-7328
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Country | US
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Telephone | 904-737-3120
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Fax | 904-730-5991
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Authorized Official
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Title or Position | CFO
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Name | BILLY WILCOX
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Credential |
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Telephone | 904-730-5756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number |
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License Number State |
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