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General NPI Number Information
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NPI Number | 1891063285
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Entity Type | Organization
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Legal Business Name | BREVARD ARTHRITIS CENTER INC
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 375 S COURTENAY PKWY #3
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4886
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Country | US
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Telephone | 321-453-8770
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Fax | 321-453-8770
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Provider Business Mailing Address
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Address Line | 375 S COURTENAY PKWY #3
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4886
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Country | US
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Telephone | 321-453-8770
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Fax | 321-453-8770
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE MILBURN
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Credential |
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Telephone | 321-453-8770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0046644
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License Number State | FL
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