| West Volusia Family And Sports Medicine Inc | |
|
742 N Volusia Ave Orange City FL 32763-4857 | |
| (386) 774-0016 | |
| Not Available |
| Full Name | West Volusia Family And Sports Medicine Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 742 N Volusia Ave, Orange City, Florida |
| Authorized Official Name and Position | John Hill (OWNER / PROVIDER) |
| Authorized Official Contact | 3867740016 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Volusia Family And Sports Medicine Inc Po Box 23764 Tampa FL 33623-3764 Ph: (727) 823-2188 | West Volusia Family And Sports Medicine Inc 742 N Volusia Ave Orange City FL 32763-4857 Ph: (386) 774-0016 |
| NPI Number | 1548584600 |
|---|---|
| Provider Enumeration Date | 03/18/2010 |
| Last Update Date | 08/04/2020 |
| Medicare PECOS PAC ID | 1456483098 |
|---|---|
| Medicare Enrollment ID | O20100719000256 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548584600 | NPI | - | NPPES |
| 002241400 | Medicaid | FL | |
| 000TF | Other | FL | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME93242 (Florida) | Primary |
| Provider Name | John M Hill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558380444 PECOS PAC ID: 4789619362 Enrollment ID: I20051003000433 |
| Provider Name | Angelia Lynn Fuller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366866204 PECOS PAC ID: 7517182785 Enrollment ID: I20140701001463 |
| Provider Name | Steven Trai Shinn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144648809 PECOS PAC ID: 9234450123 Enrollment ID: I20190612001823 |
| Provider Name | John C Hervert |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235428921 PECOS PAC ID: 1355585753 Enrollment ID: I20211116001804 |
| Provider Name | Nathan S Kim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558823922 PECOS PAC ID: 8820327844 Enrollment ID: I20220813000194 |
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