Provider Demographics
NPI:1477509636
Name:VIERA SPORTS MEDICINE & ORTHOPEDIC CENTER, INC
Entity Type:Organization
Organization Name:VIERA SPORTS MEDICINE & ORTHOPEDIC CENTER, INC
Other - Org Name:THE ORTHOPEDIC & SPORTS MEDICINE CENTER OF BREVARD, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-434-9200
Mailing Address - Street 1:8725 N. WICKHAM RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-434-9200
Mailing Address - Fax:321-434-9202
Practice Address - Street 1:8725 N. WICKHAM RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-434-9200
Practice Address - Fax:321-434-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0974Medicare UPIN
FL1303030001Medicare NSC