Space Coast Medical, LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

SPACE COAST MEDICAL, LLC

Practice address

935 Barefoot Blvd
BLDG 1 Suite 2
Barefoot Bay, FL 32976-7620

Phone

(321) 557-4667

NPI assigned

Jul 3, 2012

Last updated

Jul 28, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jason Lail

Title

C.E.O.

Phone

(321) 557-4667

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438041600000",
    "number": "1376807511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4295 N US HIGHWAY 1",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329354822",
            "telephone_number": "321-557-4667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 BAREFOOT BLVD",
            "address_2": "BLDG 1 SUITE 2",
            "city": "BAREFOOT BAY",
            "state": "FL",
            "postal_code": "329767620",
            "telephone_number": "321-557-4667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-03",
        "last_updated": "2015-07-28",
        "status": "A",
        "authorized_official_last_name": "LAIL",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "321-557-4667"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "OS6898",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Carmencita E Shaw, DNP
• Pio Sian, MD
• Sharon Ann Wareing, PMHNP
• John Valdis Zudans, M.D.

• Rehabilitation Clinic/Center in Barefoot Bay, FL
• Providers in Barefoot Bay, FL by specialty
• Rehabilitation Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; 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.