Healthcare Provider Details

I. General information

NPI: 1205875671
Provider Name (Legal Business Name): CENTRAL BREVARD ANESTHESIOLOGISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LONGWOOD AVE ATTN: 2ND FLOOR OPERATING ROOM
ROCKLEDGE FL
32955
US

IV. Provider business mailing address

P.O. BOX 561420
ROCKLEDGE FL
32956
US

V. Phone/Fax

Practice location:
  • Phone: 321-637-2616
  • Fax: 321-637-2986
Mailing address:
  • Phone: 321-637-2616
  • Fax: 321-637-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREA ORPHANOS
Title or Position: PRESIDENT
Credential: MD
Phone: 321-637-2616