NPIMap

Organization Active NPI

Brevard Family Walk in Clinic Rockledge

  • Non-Pharmacy Dispensing Site
  • Rockledge, FL
National Provider Identifier
1265846943
Registry record updated Jun 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
ME86649 Issued in FL
Legal business name
BREVARD FAMILY WALK IN CLINIC ROCKLEDGE
Doing business as
Brevard Family Walk In Clinic LLC
Practice address
1950 US Highway 1
Rockledge, FL 32955-3763
Phone
(321) 636-0005
NPI assigned
Jun 20, 2014
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2014

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

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 964-1506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X ME86649 FL Primary

Addresses

Primary practice location

1950 US Highway 1
Rockledge, FL 32955-3763

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • Brevard Family Walk In Clinic LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Brevard Family Walk in Clinic LLC2 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 1

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

Locations

1950 US Highway 1
Rockledge, FL 32955
Phone (321) 636-0005

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1403222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403222400000",
    "number": "1265846943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 US HIGHWAY 1",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "329553763",
            "telephone_number": "321-636-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREVARD FAMILY WALK IN CLINIC ROCKLEDGE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2014-06-20",
        "last_updated": "2014-06-20",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "ME86649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brevard Family Walk In Clinic LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockledge, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; 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.