1841829280 NPI number — NORTH BREVARD MEDICAL SUPPORT, INC

Table of content: (NPI 1841829280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841829280 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:
Provider Other Organization Name Type Code:
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:
1841829280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
951 N WASHINGTON AVE
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:
32796-2163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-268-6111
Provider Business Mailing Address Fax Number:
321-268-6231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7075 N US HIGHWAY 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCOA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32927-5216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-268-6111
Provider Business Practice Location Address Fax Number:
321-268-6231
Provider Enumeration Date:
04/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MIKITARIAN
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
321-268-6111

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com