Provider Demographics
NPI:1891063285
Name:BREVARD ARTHRITIS CENTER INC
Entity Type:Organization
Organization Name:BREVARD ARTHRITIS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-453-8770
Mailing Address - Street 1:375 S COURTENAY PKWY
Mailing Address - Street 2:#3
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4886
Mailing Address - Country:US
Mailing Address - Phone:321-453-8770
Mailing Address - Fax:321-453-8770
Practice Address - Street 1:375 S COURTENAY PKWY
Practice Address - Street 2:#3
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4886
Practice Address - Country:US
Practice Address - Phone:321-453-8770
Practice Address - Fax:321-453-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0046644261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty