| Entity Name: | MEDICAL CENTER OF DELTONA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 18 Jul 2019 (6 years ago) |
| Last Event: | AMENDED AND RESTATED ARTICLES |
| Event Date Filed: | 28 Feb 2020 (5 years ago) |
| Document Number: | N19000007627 |
| FEI/EIN Number | 842569909 |
| Mail Address: | 303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114, US |
| Address: | 3300 HALIFAX CROSSING BLVD, DELTONA, FL, 32725, US |
| ZIP code: | 32725 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003465097 | 2019-09-11 | 2020-06-22 | 303 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 321142700, US | 3300 HALIFAX CROSSINGS BLVD., DELTONA, FL, 32725, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 386-254-4000 |
Authorized person
| Name | ERIC M PEBURN |
| Role | CFO |
| Phone | 3864254568 |
Taxonomy
| Taxonomy Code | 282N00000X - General Acute Care Hospital |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | NJC |
| State | FL |
| Issuer | MEDICAID |
| Number | 105531100 |
| State | FL |
| Issuer | MEDICARE/OSCAR CERTIFICATION |
| Number | 10-0330 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KWIATEK KELLY | Agent | 303 N. CLYDE MORRIS BLVD., DAYTONA BEACH, FL, 32114 |
| Name | Role | Address |
|---|---|---|
| FEASEL JEFF | President | 303 N. CLYDE MORRIS BLVD., DAYTONA BEACH, FL, 32114 |
| Name | Role | Address |
|---|---|---|
| FEASEL JEFF | Secretary | 303 N. CLYDE MORRIS BLVD., DAYTONA BEACH, FL, 32114 |
| Name | Role | Address |
|---|---|---|
| FEASEL JEFF | Director | 303 N. CLYDE MORRIS BLVD., DAYTONA BEACH, FL, 32114 |
| KURAK ANDREA | Director | 303 N. CLYDE MORRIS BLVD., DAYTONA BEACH, FL, 32114 |
| VIEL STEPHEN | Director | 303 N. CLYDE MORRIS BLVD., DAYTONA BEACH, FL, 32114 |
| Ramirez Rafael | Director | 3300 Halifax Crossing Blvd., Deltona, FL, 32725 |
| Young Bill Esq. | Director | 653-1 W. 8th Street, Jacksonville, FL, 32209 |
| Morey Timothy Dr. | Director | 1600 S.W. Archer Rd., Gainesville, FL, 32610 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000055965 | MEDICAL CENTER OF DELTONA - GASTROENTEROLOGY | ACTIVE | 2022-05-03 | 2027-12-31 | No data | 3400 HALIFAX CROSSING BOULEVARD, SUITE 120C, DELTONA, FL, 32725 |
| G20000125693 | BROOKS REHABILITATION AT MEDICAL CENTER OF DELTONA | ACTIVE | 2020-09-28 | 2025-12-31 | No data | 3300 HALIFAX CROSSING BOULEVARD, DELTONA, FL, 32725 |
| G20000114625 | MEDICAL CENTER OF DELTONA - PRIMARY CARE | ACTIVE | 2020-09-03 | 2025-12-31 | No data | 3400 HALIFAX CROSSING BOULEVARD, SUITE 120A, DELTONA, FL, 32725 |
| G20000114627 | MEDICAL CENTER OF DELTONA - PEDIATRIC CARE | ACTIVE | 2020-09-03 | 2025-12-31 | No data | 3400 HALIFAX CROSSING BOULEVARD, SUITE 120B, DELTONA, FL, 32725 |
| G19000093494 | HALIFAX HEALTH | UF HEALTH - MEDICAL CENTER OF DELTONA | ACTIVE | 2019-08-27 | 2029-12-31 | No data | 3300 HALIFAX CROSSING BOULEVARD, DELTONA, FL, 32725 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-02 | 3300 HALIFAX CROSSING BLVD, DELTONA, FL 32725 | No data |
| AMENDED AND RESTATEDARTICLES | 2020-02-28 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2020-02-28 | 3300 HALIFAX CROSSING BLVD, DELTONA, FL 32725 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| AMENDED ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2024-02-26 |
| ANNUAL REPORT | 2023-03-28 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-03-02 |
| ANNUAL REPORT | 2020-04-08 |
| Amended and Restated Articles | 2020-02-28 |
| Domestic Non-Profit | 2019-07-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
