Provider Demographics
NPI:1619927464
Name:MERRITT-TITUS PA
Entity Type:Organization
Organization Name:MERRITT-TITUS PA
Other - Org Name:ROYAL OAKS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-269-2028
Mailing Address - Street 1:1855 KNOX MCRAE DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5492
Mailing Address - Country:US
Mailing Address - Phone:321-269-2028
Mailing Address - Fax:321-267-8814
Practice Address - Street 1:1855 KNOX MCRAE DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5492
Practice Address - Country:US
Practice Address - Phone:321-269-2028
Practice Address - Fax:321-267-8814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77866Medicare ID - Type UnspecifiedFLORIDA MEDICARE