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Organization
SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
Active
Organization
SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
Active
Parent organization
SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
Other names
AdventHealth Medical Group, Southwest Volusia Professional Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
Authorized official
KYLE GLASS (CHIEF FINANCIAL OFFICER)
(386) 917-5017
Entity
Organization
Contact information
Practice address
1055 SAXON BLVD, ORANGE CITY, FL 32763-8468
(386) 917-5017
(386) 917-5019
Mailing address
PO BOX 864623, ORLANDO, FL 32886-4623
(386) 671-4519
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21677
BCBS FL
FL
Enumeration date
12/28/2007
Last updated
02/26/2021
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