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NPI Code Detail

MEDICARE: BREVARD HEALTH ALLIANCE INC

MEDICARE: BREVARD HEALTH ALLIANCE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528115458
Entity Type Code : Organization
Provider Name (Legal Business Name) : BREVARD HEALTH ALLIANCE INC
Provider Business Mailing Address
First Line : 17 SILVER PALM AVE
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-3123
Country : US
Telephone Number : 321-733-2021
Fax Number : 321-727-0884
Provider Business Practice Location Address
First Line : 17 SILVER PALM AVE
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-3123
Country : US
Telephone Number : 321-733-2021
Fax Number : 321-727-0884
Authorized Official
Title or Position : BUSINESS OFFICE MANAGER
Name : ANGELA CRAIG
Credential :
Telephone Number : 321-952-9696
Provider Enumeration Date : 01/04/2007
Last Update Date : 02/18/2014

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Directions to “BREVARD HEALTH ALLIANCE INC ” Practice Location

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