Provider Demographics
NPI:1992181077
Name:MDPA SOLUTIONS, INC
Entity Type:Organization
Organization Name:MDPA SOLUTIONS, INC
Other - Org Name:NEW SMYRNA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:FORT
Authorized Official - Suffix:III
Authorized Official - Credentials:PA
Authorized Official - Phone:386-957-3810
Mailing Address - Street 1:502 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7325
Mailing Address - Country:US
Mailing Address - Phone:386-957-3810
Mailing Address - Fax:386-878-4967
Practice Address - Street 1:502 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168
Practice Address - Country:US
Practice Address - Phone:386-957-3810
Practice Address - Fax:386-878-4967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty