Neuroplace P.a.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

ME104201 Issued in FL

Legal business name

NEUROPLACE P.A.

Practice address

6290 Betty Ave
Cocoa, FL 32927-4202

Phone

(321) 301-4299

Fax

(321) 301-4299

NPI assigned

Apr 1, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Vesna Micic, M.D.

Title

President

Phone

(832) 370-3789

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396310400000",
    "number": "1396163952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6290 BETTY AVE",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329274202",
            "telephone_number": "321-301-4299",
            "fax_number": "321-301-4299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6290 BETTY AVE",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329274202",
            "telephone_number": "321-301-4299",
            "fax_number": "321-301-4299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROPLACE P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-01",
        "last_updated": "2014-04-01",
        "status": "A",
        "authorized_official_last_name": "MICIC",
        "authorized_official_first_name": "VESNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "832-370-3789",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "ME104201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002469900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Cocoa, FL
• Providers in Cocoa, FL by specialty
• Medical Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.