# NORTH BREVARD MEDICAL SUPPORT, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295409928
- **Authorized official:** KENT ANDREW BAILEY (VP FINANCE)
- **Authorized official phone:** (321) 268-6111

## Contact information

- **Practice address:** 5005 PORT ST JOHN PKWY STE 2200, PORT ST JOHN, FL 32927-4305
- **Practice address phone:** (321) 633-8663
- **Practice address fax:** (321) 633-8618
- **Mailing address:** 805 CENTURY MEDICAL DR STE C, TITUSVILLE, FL 32796-2100
- **Mailing address phone:** (321) 268-6264
- **Mailing address fax:** (321) 268-6273

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/05/2021
- **Last updated:** 08/05/2021