Provider Demographics
NPI:1134137367
Name:VOLUSIA NEUROLOGIC ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:VOLUSIA NEUROLOGIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GALE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-427-3700
Mailing Address - Street 1:405 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7109
Mailing Address - Country:US
Mailing Address - Phone:386-427-3700
Mailing Address - Fax:386-427-1890
Practice Address - Street 1:405 DOWNING ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7109
Practice Address - Country:US
Practice Address - Phone:386-427-3700
Practice Address - Fax:386-427-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21379Medicare ID - Type Unspecified