Provider Demographics
NPI:1558836361
Name:SPACE COAST HEALTH CARE NETWORK
Entity Type:Organization
Organization Name:SPACE COAST HEALTH CARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:DELIGDISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-727-2990
Mailing Address - Street 1:1344 S APOLLO BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3185
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:1344 S APOLLO BLVD STE 303
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3185
Practice Address - Country:US
Practice Address - Phone:321-727-2990
Practice Address - Fax:321-724-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty