| Psychiatric Services Of Daytona, Plcc | |
|
1651 N Clyde Morris Blvd Daytona Beach FL 32117-5500 | |
| (386) 767-8584 | |
| Not Available |
| Full Name | Psychiatric Services Of Daytona, Plcc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1651 N Clyde Morris Blvd, Daytona Beach, Florida |
| Authorized Official Name and Position | Gary Frick (CEO) |
| Authorized Official Contact | 3862655512 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychiatric Services Of Daytona, Plcc 804 Dunlawton Ave Ste 1 Port Orange FL 32127-4931 Ph: (386) 767-8584 | Psychiatric Services Of Daytona, Plcc 1651 N Clyde Morris Blvd Daytona Beach FL 32117-5500 Ph: (386) 767-8584 |
| NPI Number | 1891373601 |
|---|---|
| Provider Enumeration Date | 04/01/2021 |
| Last Update Date | 09/20/2024 |
| Certification Date | 09/20/2024 |
| Medicare PECOS PAC ID | 7012310485 |
|---|---|
| Medicare Enrollment ID | O20210722001197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891373601 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Gary W Frick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962548552 PECOS PAC ID: 7618861337 Enrollment ID: I20040212000092 |
| Provider Name | Kelli N Bridgman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588841977 PECOS PAC ID: 1951470764 Enrollment ID: I20210820000634 |
| Provider Name | Melissa H Acham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659084481 PECOS PAC ID: 9436503281 Enrollment ID: I20230927001654 |
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