Organization
SPACE COAST RADIOLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH FLYNN D. O. (VICE PRESIDENT)
(321) 268-6192
Entity
Organization
Contact information
Practice address
951 N WASHINGTON AVE, TITUSVILLE, FL 32796-2163
(321) 268-6192
Mailing address
PO BOX 3148, INDIANAPOLIS, IN 46206-3148
(855) 206-8407
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00250
BCBS PROVIDER NUMBER
FL
05
—
056061800
—
FL
05
—
056061801
—
FL
05
—
056061802
—
FL
05
—
056061803
—
FL
01
—
CK0840
RR MEDICARE
FL
Enumeration date
05/08/2006
Last updated
07/21/2022
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