Provider Demographics
NPI:1295275378
Name:DELAND MEDICAL CENTER LLC
Entity type:Organization
Organization Name:DELAND MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O. MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YVES
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAVENTURE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-624-7977
Mailing Address - Street 1:320 S SPRING GARDEN AVE
Mailing Address - Street 2:STE D
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-5087
Mailing Address - Country:US
Mailing Address - Phone:386-624-7977
Mailing Address - Fax:386-873-4147
Practice Address - Street 1:320 S SPRING GARDEN AVE
Practice Address - Street 2:STE D
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5087
Practice Address - Country:US
Practice Address - Phone:386-624-7977
Practice Address - Fax:386-873-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty