Spruce Creek Family Care

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SPRUCE CREEK FAMILY CARE

Practice address

3875 S Nova Rd
Port Orange, FL 32127-4950

Phone

(386) 322-9244

NPI assigned

Feb 7, 2008

Last updated

Feb 7, 2008By 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

Michelle Cavanaugh

Title

Billing MGR

Phone

(386) 274-5712

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Morgan Dietch III, M.D.

  • Family Medicine Physician
  • Port Orange, FL
  • NPI 1043224538
  NPD

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202342400000",
    "number": "1700064102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3875 S NOVA RD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3875 S NOVA RD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274950",
            "telephone_number": "386-322-9244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRUCE CREEK FAMILY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2008-02-07",
        "status": "A",
        "authorized_official_last_name": "CAVANAUGH",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "BILLING MGR",
        "authorized_official_telephone_number": "386-274-5712"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vickie Lynn Sorrell, FNP-BC
• Sovereign Healthcare of Port Orange, LLC (Port Orange Nursing & Rehab Center)
• Space Coast Spine LLC.
• Deanna Kingsley Springer, M.D.
• Spruce Creek Counseling, LLC
• Spruce Creek Mental Health Services, LLC
• Spruce Dental, LLC (Spruce Dental)
• Anunporn Srisawat, M.D.
• Shannon St Amant, D.C.
• Lisa St. Louis, PHARMD

• Family Medicine Physician in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2008; 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.