Healthcare Provider Details

I. General information

NPI: 1851738306
Provider Name (Legal Business Name): HOLMES REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

1350 SOUTH HICKORY STREET
MELBOURNE FL
32901-3224
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-7355
  • Fax:
Mailing address:
  • Phone: 321-434-7355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN PULIO
Title or Position: EVP CFO
Credential:
Phone: 301-315-3569