Healthcare Provider Details

I. General information

NPI: 1285668137
Provider Name (Legal Business Name): EADS MEDICAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 STERTHAUS AVE STE A
ORMOND BEACH FL
32174-5132
US

IV. Provider business mailing address

800 STERTHAUS AVE STE A
ORMOND BEACH FL
32174-5132
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-5411
  • Fax: 386-673-2285
Mailing address:
  • Phone: 386-673-5411
  • Fax: 386-673-2285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0007549
License Number StateFL

VIII. Authorized Official

Name: DR. ELIZABETH ANNE EADS
Title or Position: OWNER
Credential: D.O.
Phone: 385-673-5411