Basic Information
| Provider Information | |||||||||
| NPI: | 1114028172 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEMORIAL EMERGENCY SPECIALISTS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 NW 66TH AVE # 200A | ||||||||
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| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333134571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004433672 | ||||||||
| FaxNumber: | 9545844615 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 S TAFT AVE | ||||||||
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| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434203200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193327321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCTAGUE | ||||||||
| AuthorizedOfficialFirstName: | JEROME | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8004433672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.