Space Coast Surgery LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME 96869 Issued in FL

Legal business name

SPACE COAST SURGERY LLC

Practice address

8255 N Wickham Rd
Suite 102
Melbourne, FL 32940-8202

Phone

(321) 242-7060

Fax

(321) 242-6050

NPI assigned

Mar 5, 2009

Last updated

Aug 26, 2014By 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

Dr. Chinmay S. Majmundar, M.D.

Title

Physcian/Owner

Phone

(321) 242-7060

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1236211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409011200000",
    "number": "1760622526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8255 N WICKHAM RD",
            "address_2": "SUITE 102",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408202",
            "telephone_number": "321-242-7060",
            "fax_number": "321-242-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8255 N WICKHAM RD",
            "address_2": "SUITE 102",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408202",
            "telephone_number": "321-242-7060",
            "fax_number": "321-242-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-05",
        "last_updated": "2014-08-26",
        "status": "A",
        "authorized_official_last_name": "MAJMUNDAR",
        "authorized_official_first_name": "CHINMAY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PHYSCIAN/OWNER",
        "authorized_official_telephone_number": "321-242-7060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME 96869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Surgery Physician in Florida

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