Basic Information
| Provider Information | |||||||||
| NPI: | 1336575059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VOLUSIA MEDICAL CENTER OF DAYTONA, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 N CAUSEWAY STE A | ||||||||
| Address2: | |||||||||
| City: | NEW SMYRNA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321695328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864241584 | ||||||||
| FaxNumber: | 8889007145 | ||||||||
| Practice Location | |||||||||
| Address1: | 575 N CLYDE MORRIS BLVD | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321142323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3869575652 | ||||||||
| FaxNumber: | 8889007145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2013 | ||||||||
| LastUpdateDate: | 09/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | YEE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3864241584 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.