Organization
BREVARD HEALTH ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA CRAIG (BUSINESS OFFICE MANAGER)
(321) 952-9696
Entity
Organization
Contact information
Practice address
500 N WASHINGTON AVE, SUITE 105, TITUSVILLE, FL 32796-2759
(321) 264-5496
(321) 268-3357
Mailing address
500 N WASHINGTON AVE, SUITE 105, TITUSVILLE, FL 32796-2759
(321) 264-5496
(321) 268-3357
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6886931-13
—
FL
Enumeration date
01/18/2011
Last updated
01/20/2011
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