1205880853 NPI number — EMERGENCY MEDICINE PROFESSIONALS PA

Table of content: (NPI 1205880853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205880853 NPI number — EMERGENCY MEDICINE PROFESSIONALS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY MEDICINE PROFESSIONALS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WEST VOLUSIA EMERGENCY PHYSICIANS PA
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205880853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32120-9430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-274-7800
Provider Business Mailing Address Fax Number:
386-274-7801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 W PLYMOUTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32720-3236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-734-3220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUVA
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
386-310-2160

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 372135302 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39701 . This is a "BLUE CROSS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 372135301 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 277030000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 372135301 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".