Organization
BREVARD HMA DIAGNOSTIC IMAGING LLC
Active
Other names
Wuesthoff X-ray and Lab
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY PARRY ESQ (SR VP AND GENERAL COUNSEL)
(239) 598-3131
Entity
Organization
Contact information
Practice address
7970 N WICKHAM RD, MELBOURNE, FL 32940-8299
(321) 255-7711
(321) 255-7734
Mailing address
7970 N WICKHAM RD, MELBOURNE, FL 32940-8299
(321) 255-7711
(321) 255-7734
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
HCC3598
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051814000
—
FL
Enumeration date
03/05/2007
Last updated
09/20/2011
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