BREVARD ORTHOPAEDICS SPINE PAIN CLINIC INC MELBOURNE, FL

Contact Information

BREVARD ORTHOPAEDICS SPINE & PAIN CLINIC, INC

2222 S HARBOR CITY BLVD
SUITE 510
MELBOURNE, FL 32901-5594

Phone: 321-723-7716
Fax: 321-723-0604
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Radiologic Technologist	247100000X
Magnetic Resonance Imaging Radiologic Technologist	2471M1202X
Orthopaedic Surgery	207X00000X	02	Physician/General Surgery
Pain Medicine	2081P2900X	25	Physician/Physical Medicine and Rehabilitation
Physical Medicine & Rehabilitation	208100000X	25	Physician/Physical Medicine and Rehabilitation

Indicates primary specialty

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NPI Profile & details for BREVARD ORTHOPAEDICS SPINE PAIN CLINIC INC · (Female)

NPI Number	`1164716676`
Status	Active
Credentials
Entity	Individual
Enumeration date	06/01/2011
Last updated	07/15/2021 - About 5 years ago
Sole proprietor ¹	Not specified
Identifiers	FL Medicaid 040225700 FL Other 99949 MEDICARE
Hospital affiliation(s)	Not Available

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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