MEDICARE: COMMUNITY ACCESS TO CHILD HEALTH OF BREVARD, 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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1851439608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY ACCESS TO CHILD HEALTH OF BREVARD, INC.

Provider Business Mailing Address
First Line	:	2565 JUDGE FRAN JAMIESON WAY
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-5998
Country	:	US
Telephone Number	:	321-637-7700
Fax Number	:	321-637-7707

Provider Business Practice Location Address
First Line	:	2565 JUDGE FRAN JAMIESON WAY
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-5998
Country	:	US
Telephone Number	:	321-637-7700
Fax Number	:	321-637-7707

Authorized Official
Title or Position	:	PROGRAM ADMINISTRATOR
Name	:	MRS. SHARON B. ROSMAN
Credential	:	RN.
Telephone Number	:	321-637-7700

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	02/14/2013

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