MEDICARE: ELDER HEALTH CARE OF VOLUSIA, P.A.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1720197866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDER HEALTH CARE OF VOLUSIA, P.A.

Provider Business Mailing Address
First Line	:	2669 ENTERPRISE RD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8217
Country	:	US
Telephone Number	:	386-774-0491
Fax Number	:	386-774-7854

Provider Business Practice Location Address
First Line	:	2669 ENTERPRISE RD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8217
Country	:	US
Telephone Number	:	386-774-0491
Fax Number	:	386-774-7854

Authorized Official
Title or Position	:	CEO
Name	:	KATHLEEN M ALLEN
Credential	:	BA
Telephone Number	:	386-774-0491

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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