BREVARD ORTHOPAEDICS SPINE & PAIN CLINIC, INC; NPI #1164716676

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

NPI # 1164716676

LBN Legal business name BREVARD ORTHOPAEDICS SPINE & PAIN CLINIC, INC

Authorized official KATRINA LOPEZ - (CREDENTIALING)

Entity Organization

Organization subpart ¹ Yes

Enumeration date 06/01/2011

Last updated 07/15/2021 - About 5 years ago

Identifiers

FL	Medicaid	040225700
FL	Other	99949	MEDICARE

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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