Healthcare Provider Details

I. General information

NPI: 1508868886
Provider Name (Legal Business Name): WUESTHOFF EMERGENCY PHYSICIANS-MELBOURNE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N WICKHAM RD
MELBOURNE FL
32935-8625
US

IV. Provider business mailing address

PO BOX 552205
TAMPA FL
33655-0001
US

V. Phone/Fax

Practice location:
  • Phone: 800-476-8646
  • Fax: 919-382-3210
Mailing address:
  • Phone: 800-476-8646
  • Fax: 919-382-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. CURRIN NICHOL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 800-476-8646