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

Last updated

Oct 26, 2016By 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

Tom Willett

Title

Owner

Phone

(321) 610-7982

Specialties & licenses 1

Addresses

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

Locations

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

{
    "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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• General Practice Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• 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.