Provider Demographics
NPI:1245665199
Name:COMMUNITY HEALTH OF MELBOURNE BEACH LLC
Entity type:Organization
Organization Name:COMMUNITY HEALTH OF MELBOURNE BEACH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:FELTUS-ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-821-4882
Mailing Address - Street 1:325 5TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4273
Mailing Address - Country:US
Mailing Address - Phone:321-821-4882
Mailing Address - Fax:321-821-4890
Practice Address - Street 1:325 5TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4273
Practice Address - Country:US
Practice Address - Phone:321-821-4882
Practice Address - Fax:321-821-4890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH OF TALLAHASSEE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54282174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty