Provider Demographics
NPI:1093932113
Name:CHILDREN'S MEDICAL CENTER OF ORMOND BEACH
Entity Type:Organization
Organization Name:CHILDREN'S MEDICAL CENTER OF ORMOND BEACH
Other - Org Name:CHILDREN'S MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MRG
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:PRACTICE MGR
Authorized Official - Phone:386-523-1212
Mailing Address - Street 1:200 BOOTH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5715
Mailing Address - Country:US
Mailing Address - Phone:386-523-1212
Mailing Address - Fax:386-523-1213
Practice Address - Street 1:200 BOOTH RD
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5715
Practice Address - Country:US
Practice Address - Phone:386-523-1212
Practice Address - Fax:386-523-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty