Outreach Health Incorporated

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

OUTREACH HEALTH INCORPORATED

Practice address

240 N Frederick Ave
Daytona Beach, FL 32114-3400

Phone

(386) 255-5569

Fax

(386) 257-1245

NPI assigned

Jan 30, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Chester Lee Wilson Jr., ED.D.

Title

Chief Executive Officer

Phone

(386) 675-0098

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1580342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580342400000",
    "number": "1528699352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 N FREDERICK AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321143400",
            "telephone_number": "386-255-5569",
            "fax_number": "386-257-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 N FREDERICK AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321143400",
            "telephone_number": "386-255-5569",
            "fax_number": "386-257-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH HEALTH INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-30",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CHESTER",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "386-675-0098",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Outreach Community Care Network
• Outreach Community Care Network
• Outreach Community Care Network Inc
• Outreach Community Care Network Inc
• Outreach Community Care Network, Inc.
• Kelli Knight Overturf, APRN
• Sarah Owen, CF-SLP
• Nana Yaw Owusu, O.D.
• Alejandro Andre Pabon Rodriguez, CRNA
• Tabatha Pabon

• General Practice Physician in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; 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.