Healthcare Provider Details

I. General information

NPI: 1477261550
Provider Name (Legal Business Name): SCVIR PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 N BABCOCK ST
MELBOURNE FL
32935-7352
US

IV. Provider business mailing address

336 N BABCOCK ST
MELBOURNE FL
32935-7352
US

V. Phone/Fax

Practice location:
  • Phone: 601-954-8560
  • Fax:
Mailing address:
  • Phone: 601-954-8560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AKASH PATEL
Title or Position: OWNER
Credential: MD
Phone: 601-954-8560