MEDICARE: BREVARD MEDICAL EQUIPMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	1312632	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457351231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREVARD MEDICAL EQUIPMENT, INC.

Provider Business Mailing Address
First Line	:	105 N BANANA RIVER DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-2546
Country	:	US
Telephone Number	:	321-453-3370
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 N BANANA RIVER DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-2546
Country	:	US
Telephone Number	:	321-453-3370
Fax Number	:

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	GREG P BONENBERGER
Credential	:
Telephone Number	:	321-453-3370

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	09/30/2008

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