Provider Demographics
NPI:1124217328
Name:MELBOURNE AND PALM BAY NEPHROLOGY INC.
Entity Type:Organization
Organization Name:MELBOURNE AND PALM BAY NEPHROLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE ENTITY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCHELLE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HOFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-581-2750
Mailing Address - Street 1:7770 BAY ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3427
Mailing Address - Country:US
Mailing Address - Phone:772-581-2750
Mailing Address - Fax:772-581-8362
Practice Address - Street 1:7770 BAY ST
Practice Address - Street 2:SUITE 13
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3427
Practice Address - Country:US
Practice Address - Phone:772-581-2750
Practice Address - Fax:772-581-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82565207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261687400Medicaid
FLH42106Medicare UPIN
FL261687400Medicaid