Provider Demographics
NPI:1346977899
Name:THE VOLUSIA TRIBE COMMUNITY PREGNANCY CLINIC CORP
Entity Type:Organization
Organization Name:THE VOLUSIA TRIBE COMMUNITY PREGNANCY CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:386-227-7663
Mailing Address - Street 1:800 S NOVA RD STE R
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-7362
Mailing Address - Country:US
Mailing Address - Phone:386-227-7663
Mailing Address - Fax:386-204-7117
Practice Address - Street 1:800 S NOVA RD STE R
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-7362
Practice Address - Country:US
Practice Address - Phone:386-227-7663
Practice Address - Fax:386-204-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115566700Medicaid