Provider Demographics
NPI:1063625754
Name:MEMORIAL EKG ASSOCIATES PA
Entity type:Organization
Organization Name:MEMORIAL EKG ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-354-2600
Mailing Address - Street 1:PO BOX 919608
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9608
Mailing Address - Country:US
Mailing Address - Phone:954-726-1808
Mailing Address - Fax:954-726-1820
Practice Address - Street 1:1700 NW 66TH AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-4582
Practice Address - Country:US
Practice Address - Phone:954-726-1808
Practice Address - Fax:954-726-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98294Medicare ID - Type Unspecified