Provider Demographics
NPI:1609834886
Name:NORTH BREVARD MEDICAL SUPPORT, INC
Entity Type:Organization
Organization Name:NORTH BREVARD MEDICAL SUPPORT, INC
Other - Org Name:PARRISH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP-ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALPINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-268-6111
Mailing Address - Street 1:805 CENTURY MEDICAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2100
Mailing Address - Country:US
Mailing Address - Phone:321-268-6263
Mailing Address - Fax:321-268-6273
Practice Address - Street 1:250 HARRISON ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780
Practice Address - Country:US
Practice Address - Phone:321-268-6868
Practice Address - Fax:321-267-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265539009Medicaid
FL265539000Medicaid
FL265539000Medicaid
FL265539001Medicaid
FL265539010Medicaid
FLK3799Medicare PIN
FL265539009Medicaid
FL34447OtherBLUE CROSS BLUE SHIELD
FL265539014Medicaid
FL265539016Medicaid
FL265539000Medicaid
FLK3799Medicare PIN
FL265539002Medicaid
FL265539010Medicaid