Provider Demographics
NPI:1467014431
Name:VIA HEALTHCARE LLC
Entity Type:Organization
Organization Name:VIA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:FRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-622-8031
Mailing Address - Street 1:1341 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1986
Mailing Address - Country:US
Mailing Address - Phone:321-622-8031
Mailing Address - Fax:321-610-7487
Practice Address - Street 1:1341 BEDFORD DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1986
Practice Address - Country:US
Practice Address - Phone:321-622-8031
Practice Address - Fax:321-610-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care