# FIRST CHOICE MEDICAL GROUP OF BREVARD LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** First Choice Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578846564
- **Authorized official:** PHILLIP KELLER (CFO)
- **Authorized official phone:** (321) 725-0090

## Contact information

- **Practice address:** 650 S COURTENAY PKWY STE 100, MERRITT ISLAND, FL 32952-4977
- **Practice address phone:** (321) 725-2225
- **Practice address fax:** (321) 308-0635
- **Mailing address:** 709 S HARBOR CITY BLVD, SUITE 100, MELBOURNE, FL 32901-1938
- **Mailing address phone:** (321) 725-2225
- **Mailing address fax:** (321) 308-0635

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207T00000X | Neurological Surgery Physician | — | NULL | — |
| 207T00000X | Neurological Surgery Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/26/2011
- **Last updated:** 12/01/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 002JP | FLORIDA BLUE | FL |