Provider Demographics
NPI:1477590362
Name:BREVARD HEALTHWORX INC
Entity Type:Organization
Organization Name:BREVARD HEALTHWORX INC
Other - Org Name:BREVARD PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINARUB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:321-452-5133
Mailing Address - Street 1:1205 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-5500
Mailing Address - Country:US
Mailing Address - Phone:321-452-5133
Mailing Address - Fax:321-449-8714
Practice Address - Street 1:1205 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-5500
Practice Address - Country:US
Practice Address - Phone:321-452-5133
Practice Address - Fax:321-449-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0246Medicare PIN
FL4442830001Medicare NSC