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General NPI Number Information
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NPI Number | 1992886477
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Entity Type | Organization
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Legal Business Name | CMS ROCKLEDGE
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 2565 JUDGE FRAN JAMIESON WAY
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City | VIERA
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State | FL
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Zip | 32940-5998
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Country | US
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Telephone | 321-639-5888
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Fax | 321-690-3887
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Provider Business Mailing Address
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Address Line | 2565 JUDGE FRAN JAMIESON WAY
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City | VIERA
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State | FL
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Zip | 32940-5998
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Country | US
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Telephone | 321-639-5888
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Fax | 321-690-3887
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Authorized Official
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Title or Position | REGIONAL PROGRAM ADMINISTRATOR
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Name | MRS. CATHLEEN MARK
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Credential |
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Telephone | 407-858-5579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State | FL
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