MEDICARE: SOUTHEAST VOLUSIA HEALTHCARE CORPORATION

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	282N00000X	General Acute Care Hospital	4054	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4054	OTHER	FL	FL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871977942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST VOLUSIA HEALTHCARE CORPORATION

Provider Business Mailing Address
First Line	:	770 W GRANADA BLVD STE 203
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5179
Country	:	US
Telephone Number	:	386-231-4252
Fax Number	:	386-676-2560

Provider Business Practice Location Address
First Line	:	401 PALMETTO ST
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7322
Country	:	US
Telephone Number	:	386-424-5000
Fax Number	:	386-424-6568

Authorized Official
Title or Position	:	CFO
Name	:	NATHANAEL TORRES
Credential	:
Telephone Number	:	970-818-6061

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	02/10/2026

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Directions to “SOUTHEAST VOLUSIA HEALTHCARE CORPORATION ” Practice Location

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