Deltona Medical Center LLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

ME71092 Issued in FL

Legal business name

DELTONA MEDICAL CENTER LLC

Practice address

747 Fawn Ridge Dr
Suite 200
Orange City, FL 32763-8268

Phone

(386) 668-9800

NPI assigned

Apr 11, 2014

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• Deltona Medical Center LLC Doing business as

Part of

Tri - State Medical Group Inc

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

{
    "created_epoch": "1397174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397174400000",
    "number": "1508285032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 FAWN RIDGE DR",
            "address_2": "SUITE 200",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638268",
            "telephone_number": "386-668-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTONA MEDICAL CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2014-04-11",
        "last_updated": "2014-04-11",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ME71092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deltona Medical Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lalaine Dela Cruz, ARNP
• Brittany L Dellechiaie, APRN
• Delmar Glen Pack PA
• Deltona Medical Arts Pharmacy Inc
• Deltona Medical Center LLC
• Deltona Wellness & Psychiatry Clinic PLLC
• David Demetree, PA-C
• Denis J Gulliver Dcpa
• Denoff Orthopaedics, P.a.
• Laith Derbas, MD

• Non-Pharmacy Dispensing Site in Orange City, FL
• Providers in Orange City, FL by specialty
• Non-Pharmacy Dispensing Site in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2014; 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.