Provider Demographics
NPI:1003465097
Name:MEDICAL CENTER OF DELTONA, INC.
Entity Type:Organization
Organization Name:MEDICAL CENTER OF DELTONA, INC.
Other - Org Name:HALIFAX HEALTH UF HEALTH - MEDICAL CENTER OF DELTONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-425-4568
Mailing Address - Street 1:303 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2700
Mailing Address - Country:US
Mailing Address - Phone:386-254-4000
Mailing Address - Fax:
Practice Address - Street 1:3300 HALIFAX CROSSINGS BLVD.
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:386-254-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALIFAX HOSPITAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-11
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNJCOtherBLUE CROSS
FL105531100Medicaid
FL10-0330OtherMEDICARE/OSCAR CERTIFICATION