Provider Demographics
NPI:1902448715
Name:VOLUSIA MEDICAL CENTER LLC
Entity type:Organization
Organization Name:VOLUSIA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:386-424-1584
Mailing Address - Street 1:850 N. STONE STREET
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720
Mailing Address - Country:US
Mailing Address - Phone:386-424-1584
Mailing Address - Fax:386-410-4800
Practice Address - Street 1:850 N. STONE STREET
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720
Practice Address - Country:US
Practice Address - Phone:386-424-1584
Practice Address - Fax:386-410-4800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VOLUSIA MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009910800Medicaid