Organization
BREVARD HEALTH ALLIANCE INC
Active
Other names
Port St John Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA CRAIG (BUSINESS OFFICE MANAGER)
(321) 241-6834
Entity
Organization
Contact information
Practice address
7227 N US HIGHWAY 1, COCOA, FL 32927-5020
(321) 877-2740
Mailing address
PO BOX 1137, MELBOURNE, FL 32902-1137
(321) 952-9696
(321) 952-7937
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
05/03/2016
Last updated
06/17/2016
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