Provider Demographics
NPI:1114028172
Name:MEMORIAL EMERGENCY SPECIALISTS INC.
Entity Type:Organization
Organization Name:MEMORIAL EMERGENCY SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-443-3672
Mailing Address - Street 1:1801 NW 66TH AVE # 200A
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-4571
Mailing Address - Country:US
Mailing Address - Phone:800-443-3672
Mailing Address - Fax:954-584-4615
Practice Address - Street 1:715 S TAFT AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3200
Practice Address - Country:US
Practice Address - Phone:419-332-7321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty