Healthcare Provider Details

I. General information

NPI: 1093310872
Provider Name (Legal Business Name): FCID MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S HARBOR CITY BLVD STE 100
MELBOURNE FL
32901-1936
US

IV. Provider business mailing address

709 S HARBOR CITY BLVD STE 100
MELBOURNE FL
32901-1936
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-2225
  • Fax: 321-723-3996
Mailing address:
  • Phone: 321-725-2225
  • Fax: 321-723-3996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY DAWN BEAN
Title or Position: DIRECTOR OF MEDICAL OPERATIONS
Credential:
Phone: 321-802-5857