Provider Demographics
NPI:1841829280
Name:NORTH BREVARD MEDICAL SUPPORT, INC
Entity type:Organization
Organization Name:NORTH BREVARD MEDICAL SUPPORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKITARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT/CEO
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:321-268-6111
Mailing Address - Fax:321-268-6231
Practice Address - Street 1:7075 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-5216
Practice Address - Country:US
Practice Address - Phone:321-268-6111
Practice Address - Fax:321-268-6231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH BREVARD MEDICAL SUPPORT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty