NPIMap

Organization Active NPI

Space Coast Vascular Inc

  • Specialist
  • Melbourne, FL
National Provider Identifier
1598938250
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SPACE COAST VASCULAR INC
Practice address
655 S Apollo Blvd
Melbourne, FL 32901-1485
Phone
(321) 751-2707
Fax
(321) 255-2361
NPI assigned
Apr 2, 2008
Last updated
Sep 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Authorized official

Name
Peter S Dovgan, MDNPI 1396857611
Title
President/Ceo
Phone
(321) 751-2707

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

655 S Apollo Blvd
Melbourne, FL 32901-1485

Mailing address

655 S Apollo Blvd
Melbourne, FL 32901-1485
Phone (321) 751-2707

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1598938250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 S APOLLO BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011485",
            "telephone_number": "321-751-2707",
            "fax_number": "321-255-2361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 S APOLLO BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011485",
            "telephone_number": "321-751-2707",
            "fax_number": "321-255-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST VASCULAR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "DOVGAN",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "321-751-2707",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; 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.