# BREVARD HEALTH ALLIANCE

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

## Provider details

- **NPI number:** 1336444637
- **Authorized official:** ANGELA CRAIG (BUSINESS OFFICE MANAGER)
- **Authorized official phone:** (321) 952-9696

## Contact information

- **Practice address:** 500 N WASHINGTON AVE, SUITE 105, TITUSVILLE, FL 32796-2759
- **Practice address phone:** (321) 264-5496
- **Practice address fax:** (321) 268-3357
- **Mailing address:** 500 N WASHINGTON AVE, SUITE 105, TITUSVILLE, FL 32796-2759
- **Mailing address phone:** (321) 264-5496
- **Mailing address fax:** (321) 268-3357

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QF0400X | Federally Qualified Health Center (FQHC) | — | — | — |

## Other

- **Enumeration date:** 01/18/2011
- **Last updated:** 01/20/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6886931-13 | — | FL |