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General NPI Number Information
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NPI Number | 1326147901
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Entity Type | Organization
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Legal Business Name | SPACE COAST RHEUMATOLOGY & ARTHRITIS CENTER PA
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 40 FORTENBERRY ROAD
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City | MERRITT ISLAND
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State | FL
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Zip | 32952
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Country | US
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Telephone | 321-453-0779
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Fax |
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Provider Business Mailing Address
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Address Line | 475 INDIAN BAY BLVD
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City | MERRITT ISLAND
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State | FL
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Zip | 32953
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Country | US
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Telephone | 321-759-8640
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. LINDA ELIZABETH SALACH
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Credential | RPH
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Telephone | 321-759-8640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | OS 6549
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License Number State | FL
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