Provider Demographics
NPI:1740559855
Name:CARDIOLOGY PHYSICIANS MEMORIAL, LLC
Entity Type:Organization
Organization Name:CARDIOLOGY PHYSICIANS MEMORIAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-615-1521
Mailing Address - Street 1:305 MEMORIAL MEDICAL PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5168
Mailing Address - Country:US
Mailing Address - Phone:386-577-6361
Mailing Address - Fax:
Practice Address - Street 1:103 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-615-1521
Practice Address - Fax:386-671-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty