MEDICARE: CMS ROCKLEDGE

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	251K00000X	Public Health or Welfare Agency		FL

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

General Provider Information

NPI Number	:	1992886477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CMS ROCKLEDGE

Provider Business Mailing Address
First Line	:	2565 JUDGE FRAN JAMIESON WAY
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-5998
Country	:	US
Telephone Number	:	321-639-5888
Fax Number	:	321-690-3887

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	:	321-639-5888
Fax Number	:	321-690-3887

Authorized Official
Title or Position	:	REGIONAL PROGRAM ADMINISTRATOR
Name	:	MRS. CATHLEEN MARK
Credential	:
Telephone Number	:	407-858-5579

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	11/14/2013

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Directions to “CMS ROCKLEDGE ” Practice Location

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