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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 Medical Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHWEST VOLUSIA HEALTHCARE CORPORATION
Authorized official
MR. KYLE GLASS (CHIEF FINANCIAL OFFICER)
(386) 917-5017
Entity
Organization
Contact information
Practice address
1055 SAXON BLVD, ORANGE CITY, FL 32763-8468
(386) 917-5000
(386) 917-5848
Mailing address
770 W GRANADA BLVD STE 203, ORMOND BEACH, FL 32174-5179
(386) 231-4252
(386) 676-2560
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21677
BCBS FL
FL
Enumeration date
10/15/2007
Last updated
02/26/2021
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