Healthcare Provider Details

I. General information

NPI: 1467551762
Provider Name (Legal Business Name): CANCER CARE CENTERS OF BREVARD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 S. PINE ST.
MELBOURNE FL
32901-3119
US

IV. Provider business mailing address

PO BOX 100045
ATLANTA GA
30348-0045
US

V. Phone/Fax

Practice location:
  • Phone: 321-952-0898
  • Fax: 321-952-6296
Mailing address:
  • Phone: 321-952-0898
  • Fax: 321-952-6296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. SILAS J. CHARLES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 321-952-0898