1669750873 NPI number — BREVARD HMA HME, LLC

Table of content: (NPI 1669750873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669750873 NPI number — BREVARD HMA HME, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREVARD HMA HME, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1669750873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 BARTON BLVD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32955-2703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-632-4663
Provider Business Mailing Address Fax Number:
321-632-6090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 N WICKHAM RD
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935-8659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-242-7648
Provider Business Practice Location Address Fax Number:
321-242-7708
Provider Enumeration Date:
07/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PARRY
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
SENIOR VICE PRESIDENT/GENERAL COUNS
Authorized Official Telephone Number:
239-598-3131

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1911 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1911 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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