Provider Demographics
NPI:1669639415
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:
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:PO BOX 864623
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4623
Mailing Address - Country:US
Mailing Address - Phone:386-671-4519
Mailing Address - Fax:386-672-9904
Practice Address - Street 1:701 W PLYMOUTH AVE
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:386-943-4476
Practice Address - Fax:386-943-3685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL WEST VOLUSIA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-20
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0045Medicare PIN