Provider Demographics
NPI:1699108795
Name:TAILOR-MADE MEDICAL SOLUTIONS
Entity type:Organization
Organization Name:TAILOR-MADE MEDICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:TONY
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-492-7718
Mailing Address - Street 1:1891 N. CLYDE MORRIS BLVD, STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-492-7718
Mailing Address - Fax:386-492-7720
Practice Address - Street 1:1891 N. CLYDE MORRIS BLVD, STE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-492-7718
Practice Address - Fax:386-492-7720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:3D VISION INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4396251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care