Healthcare Provider Details

I. General information

NPI: 1104868876
Provider Name (Legal Business Name): SOUTHEAST VOLUSIA MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PALMETTO ST
NEW SMYRNA BEACH FL
32168-7322
US

IV. Provider business mailing address

PO BOX 919246
ORLANDO FL
32891-9246
US

V. Phone/Fax

Practice location:
  • Phone: 386-424-5000
  • Fax:
Mailing address:
  • Phone: 386-424-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. AL ALLRED
Title or Position: CPA FO
Credential:
Phone: 386-424-5000