| Family Health Source | |
|
801 Beville Rd Ste 101&102 South Daytona FL 32119-1860 | |
| (386) 267-6214 | |
| Not Available |
| Full Name | Family Health Source |
|---|---|
| Speciality | Clinic/Center |
| Location | 801 Beville Rd Ste 101&102, South Daytona, Florida |
| Authorized Official Name and Position | Rebecca Collier (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 3862026025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Health Source 1205 S Woodland Blvd Ste 3 Deland FL 32720-7464 Ph: (386) 202-6025 | Family Health Source 801 Beville Rd Ste 101&102 South Daytona FL 32119-1860 Ph: (386) 267-6214 |
| NPI Number | 1396282208 |
|---|---|
| Provider Enumeration Date | 01/30/2017 |
| Last Update Date | 08/10/2021 |
| Medicare PECOS PAC ID | 0547249518 |
|---|---|
| Medicare Enrollment ID | O20170621002498 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396282208 | NPI | - | NPPES |
| 687955111 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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