Healthcare Provider Details

I. General information

NPI: 1770528838
Provider Name (Legal Business Name): BREVARD SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 S APOLLO BLVD
MELBOURNE FL
32901-1485
US

IV. Provider business mailing address

665 S APOLLO BLVD
MELBOURNE FL
32901-1485
US

V. Phone/Fax

Practice location:
  • Phone: 321-984-3200
  • Fax: 321-984-2620
Mailing address:
  • Phone: 321-984-3200
  • Fax: 321-984-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberPH13979
License Number StateFL

VIII. Authorized Official

Name: ROBYN A MCDANIEL
Title or Position: DIRECTOR OF FINANCE
Credential: CPA
Phone: 321-821-7446