1104864727 NPI number — VOLUSIA HOSPITALISTS PLC

Table of content: (NPI 1104864727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104864727 NPI number — VOLUSIA HOSPITALISTS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VOLUSIA HOSPITALISTS PLC
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:
VOLUSIA HOSPITALIST PLC
Provider Other Organization Name Type Code:
3
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:
1104864727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 282004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33630-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-676-0255
Provider Business Mailing Address Fax Number:
386-676-2555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 MEMORIAL MEDICAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32117-5167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-676-0255
Provider Business Practice Location Address Fax Number:
386-676-2555
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
BROOKE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
386-676-0255

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 276566700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35736 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 94174 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 94426 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2774554200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262576800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 254097500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32081 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 007101800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009807600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14T2L . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 250751000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 276082700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42358 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 118391800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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