Provider Demographics
NPI:1386925618
Name:ANIMAL HOSPITAL OF CENTRAL BREVARD INC
Entity type:Organization
Organization Name:ANIMAL HOSPITAL OF CENTRAL BREVARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:VIOLET
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:321-751-6007
Mailing Address - Street 1:4521 N WICKHAM RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-7108
Mailing Address - Country:US
Mailing Address - Phone:321-751-6007
Mailing Address - Fax:
Practice Address - Street 1:4521 N WICKHAM RD STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7108
Practice Address - Country:US
Practice Address - Phone:321-751-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital