Provider Demographics
NPI:1669454278
Name:BREVARD EAR NOSE & THROAT CENTER PA
Entity Type:Organization
Organization Name:BREVARD EAR NOSE & THROAT CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-632-6900
Mailing Address - Street 1:1099 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2138
Mailing Address - Country:US
Mailing Address - Phone:321-632-6900
Mailing Address - Fax:321-639-7222
Practice Address - Street 1:1099 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2138
Practice Address - Country:US
Practice Address - Phone:321-632-6900
Practice Address - Fax:321-639-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherFEDERAL TAX ID