Provider Demographics
NPI:1558344689
Name:NORTH BREVARD CHILDREN'S MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTH BREVARD CHILDREN'S MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARIMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-267-5965
Mailing Address - Street 1:1653 JESS PARRISH CT
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2145
Mailing Address - Country:US
Mailing Address - Phone:321-267-5965
Mailing Address - Fax:321-267-8487
Practice Address - Street 1:1653 JESS PARRISH CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2145
Practice Address - Country:US
Practice Address - Phone:321-267-5965
Practice Address - Fax:321-267-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL229946OtherAMERIGROUP
FL081197OtherCIGNA
FL39730OtherBLUE CROSS/BLUE SHIELD
FL69355OtherAETNA