Organization Name: | MEDICAL ASSOCIATES OF BREVARD LLC |
NPI Number: | 1467461400 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GERARD L. BESSETTE (ADMINISTRATOR) |
Mailing Address: | 2107 Dairy Rd West Melbourne |
State: | FL US |
Postal Code: | 329045241 |
Phone Number: | 3216767860 |
Fax Number: | 3219527224 |
NPI Enumeration Date: | 08/07/2006 |
NPI Last Update Date: | 03/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |