Provider Demographics
NPI:1104864727
Name:VOLUSIA HOSPITALISTS PLC
Entity Type:Organization
Organization Name:VOLUSIA HOSPITALISTS PLC
Other - Org Name:VOLUSIA HOSPITALIST PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-676-0255
Mailing Address - Street 1:PO BOX 282004
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33630-2004
Mailing Address - Country:US
Mailing Address - Phone:386-676-0255
Mailing Address - Fax:386-676-2555
Practice Address - Street 1:301 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5167
Practice Address - Country:US
Practice Address - Phone:386-676-0255
Practice Address - Fax:386-676-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276566700Medicaid
FL35736OtherBLUE CROSS BLUE SHIELD
FL94174OtherBLUE CROSS BLUE SHIELD
FL94426OtherBLUE CROSS BLUE SHIELD
FL2774554200Medicaid
FL262576800Medicaid
FL254097500Medicaid
FL32081OtherBLUE CROSS BLUE SHIELD
FL007101800Medicaid
FL009807600Medicaid
FL14T2LOtherBLUE CROSS BLUE SHIELD
FL250751000Medicaid
FL276082700Medicaid
FL42358OtherBLUE CROSS BLUE SHIELD