Brevard Vascular Associates LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

ME91509 Issued in FL

Legal business name

BREVARD VASCULAR ASSOCIATES LLC

Practice address

1004 Beverly Dr
Suite D
Rockledge, FL 32955-2851

Phone

(321) 637-4710

Fax

(321) 637-4715

NPI assigned

Nov 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sandi Laroche

Title

Mso Credentialing Coordinator

Phone

(321) 449-4168

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280880000000",
    "number": "1184806630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 N SYKES CREEK PKWY",
            "address_2": "SUITE 300",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329533488",
            "telephone_number": "321-449-4168",
            "fax_number": "321-449-4164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 BEVERLY DR",
            "address_2": "SUITE D",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329552851",
            "telephone_number": "321-637-4710",
            "fax_number": "321-637-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD VASCULAR ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2010-08-04",
        "status": "A",
        "authorized_official_last_name": "LAROCHE",
        "authorized_official_first_name": "SANDI",
        "authorized_official_title_or_position": "MSO CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "321-449-4168"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "ME91509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brevard Pharmacy L.L.C.
• Brevard Physical Medicine
• Brevard Prosthetics & Orthotics, Inc
• Brevard Pulmonary Specialists PA
• Brevard Urology Associates PA
• Brevard Vision Center Inc
• Cheryl Diane Brewer-Kemppanion, BSW
• Jessica Brewer, FNP-C
• Brian S Ziegler M.D., P.a.
• Bridges BTC

• Vascular Surgery Physician in Rockledge, FL
• Providers in Rockledge, FL by specialty
• Vascular Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.