NPIMap

Organization Active NPI

North Brevard Medical Support, Inc

  • Physical Medicine & Rehabilitation Physician
  • Cape Canaveral, FL
National Provider Identifier
1225702962
Registry record updated Aug 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
NORTH BREVARD MEDICAL SUPPORT, INC
Practice address
390 Challenger Rd
Cape Canaveral, FL 32920-4200
Phone
(321) 633-8640
Fax
(321) 633-8645
NPI assigned
Aug 5, 2021
Last updated
Aug 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2021

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

Authorized official

Name
Kent Andrew Bailey
Title
VP Finance
Phone
(321) 268-6111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

390 Challenger Rd
Cape Canaveral, FL 32920-4200

Mailing address

805 Century Medical Dr Ste C
Titusville, FL 32796-2100
Phone (321) 268-6264

National Provider Directory

National Provider Directory
Tax ID family
North Brevard Medical Support Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1225702962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 CENTURY MEDICAL DR STE C",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327962100",
            "telephone_number": "321-268-6264",
            "fax_number": "321-268-6273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "390 CHALLENGER RD",
            "city": "CAPE CANAVERAL",
            "state": "FL",
            "postal_code": "329204200",
            "telephone_number": "321-633-8640",
            "fax_number": "321-633-8645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BREVARD MEDICAL SUPPORT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "321-268-6111"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Canaveral, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; 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.