Healthcare Provider Details

I. General information

NPI: 1891063285
Provider Name (Legal Business Name): BREVARD ARTHRITIS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S COURTENAY PKWY #3
MERRITT ISLAND FL
32952-4886
US

IV. Provider business mailing address

375 S COURTENAY PKWY #3
MERRITT ISLAND FL
32952-4886
US

V. Phone/Fax

Practice location:
  • Phone: 321-453-8770
  • Fax: 321-453-8770
Mailing address:
  • Phone: 321-453-8770
  • Fax: 321-453-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number0046644
License Number StateFL

VIII. Authorized Official

Name: BRUCE MILBURN
Title or Position: OWNER
Credential:
Phone: 321-453-8770