Provider Demographics
NPI:1568728608
Name:MEMORIAL HOSPITAL-WEST VOLUSIA INC
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL-WEST VOLUSIA INC
Other - Org Name:DELAND MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-943-4455
Mailing Address - Street 1:701 W PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3236
Mailing Address - Country:US
Mailing Address - Phone:386-943-4476
Mailing Address - Fax:386-615-4103
Practice Address - Street 1:701 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3236
Practice Address - Country:US
Practice Address - Phone:386-943-4476
Practice Address - Fax:386-615-4103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL WEST VOLUSIA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-03
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty