Provider Demographics
NPI:1831241470
Name:DAYTONA BEACH WOMENS CENTER INC
Entity type:Organization
Organization Name:DAYTONA BEACH WOMENS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-274-1005
Mailing Address - Street 1:1630 MASON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-4547
Mailing Address - Country:US
Mailing Address - Phone:386-274-1005
Mailing Address - Fax:386-274-5779
Practice Address - Street 1:1630 MASON AVE
Practice Address - Street 2:STE A
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4547
Practice Address - Country:US
Practice Address - Phone:386-274-1005
Practice Address - Fax:386-274-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE755Medicare PIN