Healthcare Provider Details

I. General information

NPI: 1083246334
Provider Name (Legal Business Name): URGENT CARE CENTERS OF BREVARD COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BANANA RIVER BLVD
COCOA BEACH FL
32931-5041
US

IV. Provider business mailing address

2600 WESTHALL LN STE 300
MAITLAND FL
32751-7107
US

V. Phone/Fax

Practice location:
  • Phone: 407-200-2300
  • Fax:
Mailing address:
  • Phone: 407-200-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier105815704
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 2
IdentifierK02G9
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerBCBS
# 3
IdentifierMQ224
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerMEDICARE
# 4
Identifier105815704
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name: SCOTT C BRADY
Title or Position: PRESIDENT
Credential: MD
Phone: 407-200-2300