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General NPI Number Information
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NPI Number | 1932657335
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Entity Type | Organization
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Legal Business Name | VOLUSIA ORTHOPAEDIC TRAUMA CALL ASSOCIATES LLC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 1871 LPGA BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7108
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Country | US
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Telephone | 386-366-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 1871 LPGA BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-7108
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Country | US
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Telephone | 386-255-4596
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. ALBERT W GILLESPY
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Credential | M.D.
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Telephone | 386-255-4596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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