Healthcare Provider Details

I. General information

NPI: 1750665477
Provider Name (Legal Business Name): BREVARD HYPERBARICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

551 S APOLLO BLVD SUITE 201
MELBOURNE FL
32901-1274
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-7000
  • Fax:
Mailing address:
  • Phone: 321-254-6218
  • Fax: 321-254-4139

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: RONALD T GILROY
Title or Position: PRESIDENT
Credential: MD
Phone: 321-254-6218