NPIMap

Organization Active NPI

Memorial Healthcare Group, Inc.

Doing business as Specialty Hospital Jacksonville

  • Long Term Care Hospital
  • Jacksonville, FL
National Provider Identifier
1851348429
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
MEMORIAL HEALTHCARE GROUP, INC.
Doing business as
Specialty Hospital Jacksonville
Practice address
4901 Richard St
Jacksonville, FL 32207-7328
Phone
(904) 737-3120
Fax
(904) 730-5991
NPI assigned
May 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Billy Wilcox
Title
Cfo
Phone
(904) 730-5756

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X Primary

Addresses

Primary practice location

4901 Richard St
Jacksonville, FL 32207-7328

Mailing address

4901 Richard St
Jacksonville, FL 32207-7328
Phone (904) 737-3120

Other identifiers 5

IdentifierTypeStateIssuer
044069OtherFLAVMED
10647000MedicaidFL
Y34OtherFLBLUE CROSS/HOPT
00404233MedicaidNY
000152996XMedicaidGA

Other names 1

  • SPECIALTY HOSPITAL JACKSONVILLE Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648598400000",
    "number": "1851348429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 RICHARD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322077328",
            "telephone_number": "904-737-3120",
            "fax_number": "904-730-5991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 RICHARD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322077328",
            "telephone_number": "904-737-3120",
            "fax_number": "904-730-5991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HEALTHCARE GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "BILLY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "904-730-5756"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "044069",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10647000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/HOPT",
            "identifier": "Y34",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00404233",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000152996X",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPECIALTY HOSPITAL JACKSONVILLE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SPECIALTY HOSPITAL JACKSONVILLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.