NPIMap

Organization Active NPI

C & C Healthcare LLC

  • General Practice Physician
  • Melbourne, FL
National Provider Identifier
1629476098
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ME118141 Issued in FL
Legal business name
C & C HEALTHCARE LLC
Practice address
101 E Florida Ave
Melbourne, FL 32901-8301
Phone
(321) 984-4600
NPI assigned
Dec 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Authorized official

Name
Maria A Dejesus
Title
Office Manager
Phone
(321) 615-1417

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X ME118141 FL Primary

Addresses

Primary practice location

101 E Florida Ave
Melbourne, FL 32901-8301

Mailing address

PO Box 410654
Melbourne, FL 32941-0654
Phone (321) 615-1417

Other practice location 1

4154 Waterloo Pl
Melbourne, FL 32940-1279
Phone (321) 615-1417

National Provider Directory

National Provider Directory
Tax ID family
C and C Healthcare LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1629476098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 410654",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329410654",
            "telephone_number": "321-615-1417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E FLORIDA AVE",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329018301",
            "telephone_number": "321-984-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4154 Waterloo Pl",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329401279",
            "country_code": "US",
            "telephone_number": "321-615-1417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "C & C HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "DEJESUS",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "321-615-1417"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME118141",
            "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 Oct 13, 2020; 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.