# CMS DAYTONA BEACH

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Florida Department of Health Childrens Medical Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619943677
- **Authorized official:** MS. CATHY KEATHLEY (PROGRAM ADMINISTRATOR)
- **Authorized official phone:** (352) 334-1394

## Contact information

- **Practice address:** 421 SOUTH KEECH ST, DAYTONA BEACH, FL 32114
- **Practice address phone:** (386) 238-4980
- **Practice address fax:** (386) 254-3937
- **Mailing address:** 421 SOUTH KEECH ST, DAYTONA BEACH, FL 32114
- **Mailing address phone:** (386) 238-4980
- **Mailing address fax:** (386) 254-3937

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | — | FL | Yes |

## Other

- **Enumeration date:** 02/28/2006
- **Last updated:** 08/14/2007