Healthcare Provider Details

I. General information

NPI: 1053506741
Provider Name (Legal Business Name): ADVANCED MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 BEVILLE RD
SOUTH DAYTONA FL
32119-1951
US

IV. Provider business mailing address

PO BOX 292
LAFAYETTE TN
37083-0292
US

V. Phone/Fax

Practice location:
  • Phone: 866-426-2811
  • Fax:
Mailing address:
  • Phone: 615-477-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSA 9179
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberSA 9179
License Number StateFL

VIII. Authorized Official

Name: MS. APRIL DAWN STONE
Title or Position: SPEECH PATHOLOGIST
Credential: M.S.CCC-SLP
Phone: 615-477-2072