Provider Demographics
NPI:1467551762
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:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SILAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-952-0898
Mailing Address - Street 1:PO BOX 100045
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30348-0045
Mailing Address - Country:US
Mailing Address - Phone:321-952-0898
Mailing Address - Fax:321-952-6296
Practice Address - Street 1:1430 S. PINE ST.
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3119
Practice Address - Country:US
Practice Address - Phone:321-952-0898
Practice Address - Fax:321-952-6296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372996619Medicaid
FL372996600Medicaid
FL372996601Medicaid
FL372996602Medicaid
FL372996604Medicaid
FL372996606Medicaid
FL372996618Medicaid
FL372996605Medicaid
FLCL7578OtherRR MEDICARE
FL372996603Medicaid
FL372996620Medicaid
FL372996623Medicaid