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777 Deltona Blvd Suite 21 Deltona FL 32725-7173 | |
| (386) 575-2225 | |
| (386) 575-1096 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 777 Deltona Blvd, Deltona, Florida |
| Authorized Official Name and Position | Matthew Thomas Mountain (CLINIC DIRECTOR) |
| Authorized Official Contact | 3865752225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
777 Deltona Blvd Suite 21 Deltona FL 32725-7173 Ph: (386) 575-2225 | 777 Deltona Blvd Suite 21 Deltona FL 32725-7173 Ph: (386) 575-2225 |
| NPI Number | 1417992264 |
|---|---|
| Provider Enumeration Date | 06/17/2006 |
| Last Update Date | 11/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417992264 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | CH 8010 (Florida) | Primary |
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