MEDICARE: SPACE COAST EAR NOSE AND THROAT ASSOCIATES

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	207Y00000X	Otolaryngology Physician

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	:	1790019735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPACE COAST EAR NOSE AND THROAT ASSOCIATES

Provider Business Mailing Address
First Line	:	1344 S APOLLO BLVD STE 301
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3185
Country	:	US
Telephone Number	:	321-676-2353
Fax Number	:	321-308-4020

Provider Business Practice Location Address
First Line	:	1344 S APOLLO BLVD STE 301
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3185
Country	:	US
Telephone Number	:	321-676-2353
Fax Number	:	321-308-4020

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. STEVEN YIH-CHERNG HO
Credential	:	M.D.
Telephone Number	:	321-676-2353

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	03/01/2021

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