Basic Information
| Provider Information | |||||||||
| NPI: | 1629279138 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VOLUSIA MEDICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3900 CLARK RD STE L2 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342332375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864241584 | ||||||||
| FaxNumber: | 8889007145 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 CLARK RD STE L2 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864241584 | ||||||||
| FaxNumber: | 8882155481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 04/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | YEE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3864241584 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME97277 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.