Good Samaritan Clinic of West Volusia, Inc.

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

License

ARNP 694272 Issued in FL

Legal business name

GOOD SAMARITAN CLINIC OF WEST VOLUSIA, INC.

Practice address

136 E Plymouth Ave
Deland, FL 32724-2871

Phone

(138) 673-8699

NPI assigned

Aug 1, 2016

Last updated

Aug 1, 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

Dr. Lyle Wadsworth

Title

Medical Director

Phone

(386) 738-6990

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1470009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470009600000",
    "number": "1730632225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 E PLYMOUTH AVE",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327242871",
            "telephone_number": "138-673-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 E PLYMOUTH AVE",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327242871",
            "telephone_number": "138-673-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN CLINIC OF WEST VOLUSIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-01",
        "last_updated": "2016-08-01",
        "status": "A",
        "authorized_official_last_name": "WADSWORTH",
        "authorized_official_first_name": "DR. LYLE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "13867386990"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "FL",
            "license": "ARNP 694272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul B Goldberg, MD
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• Brianna Golden, PHARMD
• Liliana Gomez
• William Gonzalez
• Joseph Francis Goodreau, D.D.S.
• Regina Goodson, OTR/L
• Jeremy Michael Gordon, D.C.
• Victoria Gorelik, DDS
• Dianne Briggs Goshorn, M. ED., LMHC

• Nursing Care Agency in Deland, FL
• Providers in Deland, FL by specialty
• Nursing Care Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.