NPIMap

Organization Active NPI

Northeast Florida Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Deland, FL
National Provider Identifier
1144995317
Registry record updated Aug 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST FLORIDA HEALTH SERVICES, INC.
Doing business as
FAMILY HEALTH SOURCE
Practice address
1205 S Woodland Blvd Ste 4
Deland, FL 32720-7464
Phone
(386) 202-6025
Fax
(386) 202-1755
NPI assigned
Aug 10, 2021
Organization subpart
Yes
Parent organization
NORTHEAST FLORIDA HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Laurie Asbury
Title
Ceo
Phone
(386) 202-6025

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1205 S Woodland Blvd Ste 4
Deland, FL 32720-7464

Mailing address

1205 S Woodland Blvd Ste 3
Deland, FL 32720-7464
Phone (386) 202-6025

Other identifiers 1

IdentifierTypeStateIssuer
687955118MedicaidFL

Other names 1

  • FAMILY HEALTH SOURCE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northeast Florida Health11 organizations share this tax ID, including this one
Part of
Northeast Florida Health

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628553600000",
    "number": "1144995317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 S WOODLAND BLVD STE 3",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327207464",
            "telephone_number": "386-202-6025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 S WOODLAND BLVD STE 4",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327207464",
            "telephone_number": "386-202-6025",
            "fax_number": "386-202-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST FLORIDA HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST FLORIDA HEALTH SERVICES, INC.",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-10",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "ASBURY",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "386-202-6025"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "687955118",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY HEALTH SOURCE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.