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Organization
FIRST CHOICE MEDICAL GROUP OF BREVARD LLC
Active
Organization
FIRST CHOICE MEDICAL GROUP OF BREVARD LLC
Active
Other names
First Choice Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP KELLER (CFO)
(321) 725-0090
Entity
Organization
Contact information
Practice address
650 S COURTENAY PKWY STE 100, MERRITT ISLAND, FL 32952-4977
(321) 725-2225
(321) 308-0635
Mailing address
709 S HARBOR CITY BLVD, SUITE 100, MELBOURNE, FL 32901-1938
(321) 725-2225
(321) 308-0635
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
NULL
207T00000X
Neurological Surgery Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002JP
FLORIDA BLUE
FL
Enumeration date
09/26/2011
Last updated
12/01/2020
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