National Provider Identifier Database

BREVARD ORTHOPAEDICS SPINE PAIN CLINIC INC
Radiologic Technologist

A medical imaging or radiation therapy professional who is appropriately educated and trained to perform medical imaging procedures using ionizing and nonionizing radiation.


Contact Information

BREVARD ORTHOPAEDICS SPINE & PAIN CLINIC, INC
2222 S HARBOR CITY BLVD
SUITE 510
MELBOURNE, FL32901-5594
Phone: 321-723-7716
Fax: 321-723-0604
Website:
Specialty Taxonomy Code
* Radiologic Technologist 247100000X
Magnetic Resonance Imaging Radiologic Technologist 2471M1202X
Orthopaedic Surgery 207X00000X
Pain Medicine 2081P2900X
Physical Medicine & Rehabilitation 208100000X

* Indicates primary specialty

NPI Profile & details for BREVARD ORTHOPAEDICS SPINE & PAIN CLINIC, INC

NPI Number 1164716676
Legal business name
LBN
BREVARD ORTHOPAEDICS SPINE & PAIN CLINIC, INC
Authorized official KATRINA LOPEZ - (CREDENTIALING)
Entity Organization
Organization subpart Yes
Enumeration date 06/01/2011
Last updated 07/15/2021 - About 5 years ago
Sole proprietor1 Not specified
Identifiers
  • FL Medicaid: 040225700
  • FL Other: 99949 MEDICARE

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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