Provider Demographics
NPI:1396946349
Name:VOLUSIA PRIMARY CARE ASSOCIATES
Entity type:Organization
Organization Name:VOLUSIA PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:INDRAVADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-322-2224
Mailing Address - Street 1:770 JOHN ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-4708
Mailing Address - Country:US
Mailing Address - Phone:386-322-2224
Mailing Address - Fax:386-322-2033
Practice Address - Street 1:667 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1952
Practice Address - Country:US
Practice Address - Phone:386-322-2224
Practice Address - Fax:386-322-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K1901Medicare ID - Type Unspecified
04538ZMedicare ID - Type Unspecified
D8496Medicare UPIN