Provider Demographics
NPI:1073936415
Name:VOLUSIA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:VOLUSIA MEDICAL CENTER LLC
Other - Org Name:VOLUSIA MEDICAL CENTER DAYTONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-424-1584
Mailing Address - Street 1:3900 CLARK RD STE L2
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2375
Mailing Address - Country:US
Mailing Address - Phone:386-424-1584
Mailing Address - Fax:386-410-4800
Practice Address - Street 1:711 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1823
Practice Address - Country:US
Practice Address - Phone:386-424-1584
Practice Address - Fax:386-410-4800
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDVANTX, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-21
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
FLME98112332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty