Provider Demographics
NPI:1649367269
Name:MEMORIAL HOSPITAL-WEST VOLUSIA INC
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL-WEST VOLUSIA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-497-8195
Mailing Address - Street 1:770 W GRANADA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5179
Mailing Address - Country:US
Mailing Address - Phone:386-943-4522
Mailing Address - Fax:386-943-3674
Practice Address - Street 1:701 W. PLYMOUTH AVENUE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3236
Practice Address - Country:US
Practice Address - Phone:386-943-4522
Practice Address - Fax:386-943-3674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273R00000X, 314000000X, 261QR0404X
FL4436282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL326OtherBLUE CROSS
FL6200305OtherAETNA PPO
FL010187700Medicaid
FL07283OtherAETNA HMO
FL326OtherBLUE CROSS