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General NPI Number Information
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NPI Number | 1922115914
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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 | 08/24/2006
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 305 MEMORIAL MEDICAL PKWY STE 205
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5169
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Country | US
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Telephone | 386-231-3530
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Fax |
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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 | 863-231-4252
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Fax | 386-676-2560
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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