MEDICARE: THE 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
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1558849885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BREVARD HEALTH ALLIANCE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1137
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32902-1137
Country	:	US
Telephone Number	:	321-952-9696
Fax Number	:	321-952-7937

Provider Business Practice Location Address
First Line	:	1361 FLORIDA AVE NE APT 2
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-2650
Country	:	US
Telephone Number	:	321-241-6800
Fax Number	:	321-241-6888

Authorized Official
Title or Position	:	DIRECTOR OF BILLING
Name	:	ANGELA CRAIG
Credential	:
Telephone Number	:	321-241-6834

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	04/21/2025

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