Advantacare Multi-Specialty Group, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

ADVANTACARE MULTI-SPECIALTY GROUP, LLC

Practice address

1040 Mason Ave
Daytona Beach, FL 32117-4612

Phone

(386) 248-0107

Fax

(386) 248-0109

NPI assigned

Feb 18, 2016

Last updated

Feb 24, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kerri Herzog

Title

Member

Phone

(407) 539-2111

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1455753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456272000000",
    "number": "1326407313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "697 MAITLAND AVE",
            "address_2": "SUITE 1001",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327016821",
            "telephone_number": "407-539-2111",
            "fax_number": "407-539-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 MASON AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321174612",
            "telephone_number": "386-248-0107",
            "fax_number": "386-248-0109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTACARE MULTI-SPECIALTY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-18",
        "last_updated": "2016-02-24",
        "status": "A",
        "authorized_official_last_name": "HERZOG",
        "authorized_official_first_name": "KERRI",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "407-539-2111"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Physical Medicine & Rehabilitation Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; 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.