Provider Demographics
NPI:1891197448
Name:BEACHSIDE MEDICAL CENTER
Entity Type:Organization
Organization Name:BEACHSIDE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DOOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-423-0505
Mailing Address - Street 1:1055 N DIXIE FWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6201
Mailing Address - Country:US
Mailing Address - Phone:386-957-9850
Mailing Address - Fax:386-410-3731
Practice Address - Street 1:1055 N DIXIE FWY
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6201
Practice Address - Country:US
Practice Address - Phone:386-957-9850
Practice Address - Fax:386-410-3731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty