Organization
SPACE COAST MEDICAL MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL HUSTED (CFO)
(561) 523-3973
Entity
Organization
Contact information
Practice address
1840 ELDRON BLVD SE STE 2, PALM BAY, FL 32909-6871
(561) 523-3973
Mailing address
1840 ELDRON BLVD SE STE 2, PALM BAY, FL 32909-6871
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
11/23/2020
Last updated
11/23/2020
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