Provider Demographics
NPI:1427271345
Name:BREVARD HEALTH CARE LLC
Entity type:Organization
Organization Name:BREVARD HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARCZUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-259-5999
Mailing Address - Street 1:240 N WICKHAM RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8662
Mailing Address - Country:US
Mailing Address - Phone:321-259-5999
Mailing Address - Fax:321-259-5553
Practice Address - Street 1:240 N WICKHAM RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8662
Practice Address - Country:US
Practice Address - Phone:321-259-5999
Practice Address - Fax:321-259-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty