MEDICARE: EDC OF VOLUSIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME98466	FL

General Provider Information

NPI Number	:	1285956037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDC OF VOLUSIA, LLC

Provider Business Mailing Address
First Line	:	1055 N DIXIE FWY
Second Line	:	SUITE 1
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-6201
Country	:	US
Telephone Number	:	386-423-0505
Fax Number	:	386-423-0515

Provider Business Practice Location Address
First Line	:	780 DUNLAWTON AVE
Second Line	:	SUITE 1
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4901
Country	:	US
Telephone Number	:	386-322-6111
Fax Number	:	386-322-3777

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINA RHO
Credential	:	MD
Telephone Number	:	386-322-6111

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	11/18/2014

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Directions to “EDC OF VOLUSIA, LLC ” Practice Location

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