Organization
BREVARD SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBYN A MCDANIEL CPA (DIRECTOR OF FINANCE)
(321) 821-7446
Entity
Organization
Contact information
Practice address
665 S APOLLO BLVD, MELBOURNE, FL 32901-1485
(321) 984-3200
(321) 984-2620
Mailing address
665 S APOLLO BLVD, MELBOURNE, FL 32901-1485
(321) 984-3200
(321) 984-2620
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
PH13979
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079180600
—
FL
01
—
490002578
MEDICARE ID TYPE UNSPECIFIED
FL
01
—
64E
BCBS
FL
Enumeration date
06/20/2006
Last updated
07/05/2022
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