Healthcare Provider Details

I. General information

NPI: 1811448954
Provider Name (Legal Business Name): BREVARD REGIONAL HYPERBARIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 W HIBISCUS BLVD SUITE B
MELBOURNE FL
32901
US

IV. Provider business mailing address

1698 W HIBISCUS BLVD SUITE B
MELBOURNE FL
32901
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-3200
  • Fax: 321-802-5101
Mailing address:
  • Phone: 321-676-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberOS6304
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberOS6304
License Number StateFL

VIII. Authorized Official

Name: MARY BUZA
Title or Position: MEDICAL ASSISTANT
Credential:
Phone: 321-676-3200