Provider Demographics
NPI:1750047007
Name:VOLUSIA OBL BZ, LLC
Entity type:Organization
Organization Name:VOLUSIA OBL BZ, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPPINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-692-8882
Mailing Address - Street 1:231 S BEMISTON AVE STE 850
Mailing Address - Street 2:PMB 82567
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1920
Mailing Address - Country:US
Mailing Address - Phone:727-692-8882
Mailing Address - Fax:727-487-9041
Practice Address - Street 1:1615 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:618-973-8740
Practice Address - Fax:618-235-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-11
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty