Healthcare Provider Details

I. General information

NPI: 1750899837
Provider Name (Legal Business Name): NU-ME MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N WICKHAM RD STE 9
MELBOURNE FL
32935-2322
US

IV. Provider business mailing address

3150 N WICKHAM RD STE 9
MELBOURNE FL
32935-2322
US

V. Phone/Fax

Practice location:
  • Phone: 321-241-6441
  • Fax: 321-574-5611
Mailing address:
  • Phone: 321-241-6441
  • Fax: 321-574-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME42998
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME42998
License Number StateFL

VIII. Authorized Official

Name: MR. THOMAS K VELLEFF
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 321-241-6441