Provider Demographics
NPI:1689325938
Name:MEMORIAL HOSPITAL FLAGLER INC
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL FLAGLER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RATHBUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-586-4301
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:386-231-4252
Mailing Address - Fax:386-676-2560
Practice Address - Street 1:60 MEMORIAL MEDICAL PKWY STE 500
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5980
Practice Address - Country:US
Practice Address - Phone:386-586-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL FLAGLER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-18
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities