Provider Demographics
NPI:1255950168
Name:SMA HEALTHCARE, INC
Entity type:Organization
Organization Name:SMA HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CONTRACTING COOR
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:OMALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-236-3225
Mailing Address - Street 1:150 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4304
Mailing Address - Country:US
Mailing Address - Phone:386-236-3215
Mailing Address - Fax:386-236-3178
Practice Address - Street 1:420 STADIUM ROAD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2810
Practice Address - Country:US
Practice Address - Phone:800-539-4228
Practice Address - Fax:386-236-3178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMA HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care