Provider Demographics
NPI:1477910149
Name:JM HOLDINGS OF BREVARD INC
Entity Type:Organization
Organization Name:JM HOLDINGS OF BREVARD INC
Other - Org Name:BREVARD REGIONAL HYPERBARIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BUZA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:321-676-3200
Mailing Address - Street 1:1698 W HIBISCUS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2639
Mailing Address - Country:US
Mailing Address - Phone:321-676-3200
Mailing Address - Fax:321-802-5101
Practice Address - Street 1:1698 W HIBISCUS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2639
Practice Address - Country:US
Practice Address - Phone:321-676-3200
Practice Address - Fax:321-802-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS63042083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty