Provider Demographics
NPI:1447206438
Name:MEMORIAL HEALTHCARE GROUP INC
Entity Type:Organization
Organization Name:MEMORIAL HEALTHCARE GROUP INC
Other - Org Name:HCA FLORIDA MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-702-6573
Mailing Address - Street 1:PO BOX 16325
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6325
Mailing Address - Country:US
Mailing Address - Phone:904-399-6111
Mailing Address - Fax:904-399-6849
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-399-6111
Practice Address - Fax:904-399-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108705801Medicaid
FL107927OtherAMERIGROUP
FL130OtherBLUE CROSS/HOPT
FL10193100Medicaid
SC10408BMedicaid
GA000490542XMedicaid
AR130141105Medicaid
NY01608548Medicaid
FL044013OtherAVMED
MA1009826Medicaid
TX108705801Medicaid