| Idc Of Volusia, Llc | |
|
410 Palmetto St New Smyrna Beach FL 32168-7323 | |
| (386) 410-4981 | |
| (386) 410-4982 |
| Full Name | Idc Of Volusia, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 410 Palmetto St, New Smyrna Beach, Florida |
| Authorized Official Name and Position | Reba Isaac (MD) |
| Authorized Official Contact | 3864104981 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Idc Of Volusia, Llc Po Box 70 New Smyrna Beach FL 32170-0070 Ph: (386) 410-4981 | Idc Of Volusia, Llc 410 Palmetto St New Smyrna Beach FL 32168-7323 Ph: (386) 410-4981 |
| NPI Number | 1154372241 |
|---|---|
| Provider Enumeration Date | 05/13/2006 |
| Last Update Date | 08/29/2017 |
| Medicare PECOS PAC ID | 5597826255 |
|---|---|
| Medicare Enrollment ID | O20090403000381 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154372241 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | ME89116 (Florida) | Primary |
| Provider Name | Reba K Isaac |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1356348593 PECOS PAC ID: 7911979380 Enrollment ID: I20040807000065 |
| Provider Name | Latoya D Moody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558404970 PECOS PAC ID: 4688735335 Enrollment ID: I20081212000579 |
| Provider Name | Enitan O Ekwotafia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598904278 PECOS PAC ID: 6800051665 Enrollment ID: I20120628000097 |
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