Provider Demographics
NPI:1417138249
Name:SPACE COAST HOSPITALISTS LLC
Entity Type:Organization
Organization Name:SPACE COAST HOSPITALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-394-6863
Mailing Address - Street 1:1326 MALABAR RD SE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2502
Mailing Address - Country:US
Mailing Address - Phone:321-409-3073
Mailing Address - Fax:321-409-3075
Practice Address - Street 1:1425 MALABAR ROAD NE
Practice Address - Street 2:PALM BAY COMMUNITY HOSPITAL
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907
Practice Address - Country:US
Practice Address - Phone:321-409-3073
Practice Address - Fax:321-409-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty