Medi Melbourne LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MEDI MELBOURNE LLC

Practice address

7630 N Wickham Rd Ste 104
Melbourne, FL 32940-8257

Phone

(321) 610-7982

Fax

(321) 610-7984

NPI assigned

Oct 26, 2016

Organization subpart

No

Name

Tom Willett

Title

Owner

Phone

(321) 610-7982

Tax ID family

Medi Melbourne 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.

• Medi Melbourne LLC

  • General Practice Physician
  • Melbourne, FL
  • NPI 1700256450
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 26, 2016.

{
    "created_epoch": "1477440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477440000000",
    "number": "1629520606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7630 N WICKHAM RD STE 104",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408257",
            "telephone_number": "321-610-7982",
            "fax_number": "321-610-7984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7630 N WICKHAM RD STE 104",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408257",
            "telephone_number": "321-610-7982",
            "fax_number": "321-610-7984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDI MELBOURNE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-26",
        "last_updated": "2016-10-26",
        "status": "A",
        "authorized_official_last_name": "WILLETT",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-610-7982"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Melbourne, FL
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; 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.