Provider Demographics
NPI:1326254962
Name:ORMOND MEDICAL ARTS
Entity Type:Organization
Organization Name:ORMOND MEDICAL ARTS
Other - Org Name:COMPLETE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR.DIRECTOR ENTERPRISE REVENUECYCLE
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-282-9568
Mailing Address - Street 1:841 PRUDENTIAL DR STE 1700
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8329
Mailing Address - Country:US
Mailing Address - Phone:904-800-7071
Mailing Address - Fax:904-758-5380
Practice Address - Street 1:77 W GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6302
Practice Address - Country:US
Practice Address - Phone:386-677-0453
Practice Address - Fax:386-677-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39678Medicare ID - Type UnspecifiedMEDICARE GROUP