Provider Demographics
NPI:1922258227
Name:NORTH BREVARD COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:NORTH BREVARD COUNTY HOSPITAL DISTRICT
Other - Org Name:PARRISH MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKITARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-268-6111
Mailing Address - Street 1:951 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2163
Mailing Address - Country:US
Mailing Address - Phone:321-268-6333
Mailing Address - Fax:
Practice Address - Street 1:7075 N US HIGHWAY 1
Practice Address - Street 2:STE 100
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-5216
Practice Address - Country:US
Practice Address - Phone:321-433-1439
Practice Address - Fax:321-433-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4467282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010010200Medicaid
FL100028Medicare PIN