Provider Demographics
NPI:1598860108
Name:MEMORIAL HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:MEMORIAL HEALTH SYSTEMS INC
Other - Org Name:ADVENTHEALTH DAYTONA BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-231-3906
Mailing Address - Street 1:770 W GRANADA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5179
Mailing Address - Country:US
Mailing Address - Phone:386-231-4610
Mailing Address - Fax:386-231-1298
Practice Address - Street 1:301 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5167
Practice Address - Country:US
Practice Address - Phone:386-231-6000
Practice Address - Fax:386-231-1298
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HEALTH SYSTEMS INC FLORIDA HOSPITAL ORMOND MEMORIAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-14
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4201273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010186900Medicaid
FL5000085OtherUHC
FL6201455OtherAETNA PPO
FL671569OtherAETNA HMO
FLY20OtherBLUE CROSS INPATIENT
FL334OtherBLUE CROSS OUTPATIENT
FL6201455OtherAETNA PPO