MEDICARE: MEMORIAL HEALTHCARE GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1699618116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HEALTHCARE GROUP, INC.

Provider Business Mailing Address
First Line	:	42 DOCTORS VILLAGE DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-2245
Country	:	US
Telephone Number	:	904-230-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 DOCTORS VILLAGE DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-2245
Country	:	US
Telephone Number	:	904-230-5000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	REED HAMMOND
Credential	:
Telephone Number	:	904-702-1172

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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