MEDICARE: SMA HEALTHCARE INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	407	FL
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	283Q00000X	Psychiatric Hospital

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1750369666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMA HEALTHCARE INC

Provider Business Mailing Address
First Line	:	150 MAGNOLIA AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4304
Country	:	US
Telephone Number	:	386-236-3225
Fax Number	:	386-236-3175

Provider Business Practice Location Address
First Line	:	1150 RED JOHN DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32124-1016
Country	:	US
Telephone Number	:	386-236-3225
Fax Number	:	386-236-3175

Authorized Official
Title or Position	:	CEO
Name	:	MR. IVAN A COSIMI
Credential	:
Telephone Number	:	386-236-1811

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	11/08/2024

1150 RED JOHN DR BLDG A
DAYTONA BEACH, FL
32124-1016

Practice Phone: 800-539-4228
Practice Fax: