Organization
MEMORIAL HEALTH SYSTEM
Active
Other names
Memorial Hospital Phys Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE SCIALDONE (CEO)
(719) 365-2068
Entity
Organization
Contact information
Practice address
1400 E BOULDER ST, COLORADO SPRINGS, CO 80909-5533
(719) 365-5000
Mailing address
PO BOX 460, COLORADO SPRINGS, CO 80901-0460
(719) 365-5242
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0244
CO
207R00000X
Internal Medicine Physician
0244
CO
207V00000X
Obstetrics & Gynecology Physician
0244
CO
208000000X
Pediatrics Physician
0244
CO
208600000X
Surgery Physician
0244
CO
208M00000X
Hospitalist Physician
0244
CO
282N00000X
General Acute Care Hospital
Primary
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04762084
—
CO
01
—
C5004
BLUE CROSS
CO
Enumeration date
06/25/2007
Last updated
07/21/2022
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