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General NPI Number Information
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NPI Number | 1558329581
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Entity Type | Organization
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Legal Business Name | SPACE COAST MEDICAL ASSOCIATES LLP
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 490 N WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32796-2871
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Country | US
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Telephone | 311-268-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 490 N WASHINGTON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32796-2871
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Country | US
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Telephone | 311-268-4200
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | RICHARD LEVINE
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Credential | MD
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Telephone | 321-454-9001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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