1609834886 NPI number — NORTH BREVARD MEDICAL SUPPORT, INC

Table of content: (NPI 1609834886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609834886 NPI number — NORTH BREVARD MEDICAL SUPPORT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH BREVARD MEDICAL SUPPORT, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARRISH MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609834886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 CENTURY MEDICAL DR STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TITUSVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32796-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-268-6263
Provider Business Mailing Address Fax Number:
321-268-6273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 HARRISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TITUSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-268-6868
Provider Business Practice Location Address Fax Number:
321-267-2713
Provider Enumeration Date:
05/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCALPINE
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VP-ADMINISTRATION
Authorized Official Telephone Number:
321-268-6111

Provider Taxonomy Codes

  • Taxonomy code: 163WW0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 265539009 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 265539000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".