Provider Demographics
NPI:1316147606
Name:SURGICAL SPECIALISTS OF CENTRAL BREVARD PA
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS OF CENTRAL BREVARD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-783-8400
Mailing Address - Street 1:PO BOX 320388
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32932-0388
Mailing Address - Country:US
Mailing Address - Phone:321-783-8400
Mailing Address - Fax:321-783-7129
Practice Address - Street 1:1980 N ATLANTIC AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5213
Practice Address - Country:US
Practice Address - Phone:321-783-8400
Practice Address - Fax:321-783-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72513AMedicare PIN