Provider Demographics
NPI:1841224953
Name:WEST VOLUSIA PEDIATRICS, PA
Entity Type:Organization
Organization Name:WEST VOLUSIA PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:VANHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-734-1824
Mailing Address - Street 1:809 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3255
Mailing Address - Country:US
Mailing Address - Phone:386-734-1824
Mailing Address - Fax:386-738-7497
Practice Address - Street 1:809 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3255
Practice Address - Country:US
Practice Address - Phone:386-734-1824
Practice Address - Fax:386-738-7497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID