Provider Demographics
NPI:1437303385
Name:MELBOURNE COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:MELBOURNE COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:
Authorized Official - Last Name:RADFAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-728-0000
Mailing Address - Street 1:PO BOX 373040
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-1040
Mailing Address - Country:US
Mailing Address - Phone:321-728-0000
Mailing Address - Fax:321-728-0004
Practice Address - Street 1:15 E HIBISCUS BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3101
Practice Address - Country:US
Practice Address - Phone:321-728-0000
Practice Address - Fax:321-728-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care