Provider Demographics
NPI:1114590429
Name:CANCER CARE CENTERS OF BREVARD INC
Entity Type:Organization
Organization Name:CANCER CARE CENTERS OF BREVARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:ERENTREICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-636-2111
Mailing Address - Street 1:1430 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3119
Mailing Address - Country:US
Mailing Address - Phone:321-674-5050
Mailing Address - Fax:
Practice Address - Street 1:20 SAN FILIPPO DR SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-2200
Practice Address - Country:US
Practice Address - Phone:321-725-8300
Practice Address - Fax:321-725-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty