Provider Demographics
NPI:1134442205
Name:FCID FLORIDA, INC.
Entity type:Organization
Organization Name:FCID FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BITTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-750-0090
Mailing Address - Street 1:709 S HARBOR CITY BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1938
Mailing Address - Country:US
Mailing Address - Phone:321-750-0090
Mailing Address - Fax:
Practice Address - Street 1:1071 PORT MALABAR BLVD NE
Practice Address - Street 2:SUITE 104
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-5161
Practice Address - Country:US
Practice Address - Phone:321-725-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FCID HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)