Provider Demographics
NPI:1992928618
Name:MEMORIAL EKG ASSOCIATES
Entity type:Organization
Organization Name:MEMORIAL EKG ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-396-2342
Mailing Address - Street 1:PO BOX 5909
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32247-5909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:904-396-4279
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-399-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99405Medicare ID - Type UnspecifiedMEDICARE