Provider Demographics
NPI:1851348429
Name:MEMORIAL HEALTHCARE GROUP, INC.
Entity Type:Organization
Organization Name:MEMORIAL HEALTHCARE GROUP, INC.
Other - Org Name:SPECIALTY HOSPITAL JACKSONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-730-5756
Mailing Address - Street 1:4901 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-7328
Mailing Address - Country:US
Mailing Address - Phone:904-737-3120
Mailing Address - Fax:904-730-5991
Practice Address - Street 1:4901 RICHARD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-7328
Practice Address - Country:US
Practice Address - Phone:904-737-3120
Practice Address - Fax:904-730-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044069OtherAVMED
FL10647000Medicaid
FLY34OtherBLUE CROSS/HOPT
NY00404233Medicaid
GA000152996XMedicaid
NY00404233Medicaid