1346977899 NPI number — THE VOLUSIA TRIBE COMMUNITY PREGNANCY CLINIC CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346977899 NPI number — THE VOLUSIA TRIBE COMMUNITY PREGNANCY CLINIC CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE VOLUSIA TRIBE COMMUNITY PREGNANCY CLINIC CORP
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:
Provider Other Organization Name Type Code:
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:
1346977899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 S NOVA RD STE R
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORMOND BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32174-7362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-227-7663
Provider Business Mailing Address Fax Number:
386-204-7117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 S NOVA RD STE R
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-7362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-227-7663
Provider Business Practice Location Address Fax Number:
386-204-7117
Provider Enumeration Date:
08/04/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BURR
Authorized Official First Name:
SERENA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
386-227-7663

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 374J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 115566700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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