1386751907 NPI number — FLORIDA DEPARTMENT OF HEALTH

Table of content: (NPI 1386751907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386751907 NPI number — FLORIDA DEPARTMENT OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA DEPARTMENT OF HEALTH
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:
BREVARD COUNTY HEALTH DEPARTMENT
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:
1386751907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2565 JUDGE FRAN JAMIESON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIERA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32940-5998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-454-7148
Provider Business Mailing Address Fax Number:
321-449-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2555 JUDGE FRAN JAMIESON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIERA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940-5998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-639-5800
Provider Business Practice Location Address Fax Number:
321-449-5015
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DWECK
Authorized Official First Name:
MURRAY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
321-454-7148

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 051925102 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051925192 . This is a "MEDIPASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051925193 . This is a "MEDIPASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051925101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051925100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051925191 . This is a "MEDIPASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051925100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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