Space Coast Pain Relief Inc.

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

ME84507 Issued in FL

Legal business name

SPACE COAST PAIN RELIEF INC.

Practice address

3550 S Washington Ave
Suite 24
Titusville, FL 32780-8627

Phone

(321) 269-5533

Fax

(321) 269-3009

NPI assigned

Mar 1, 2007

Organization subpart

No

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

Authorized official

Name

Ibem Roandlo Borges, M.D.

Title

Medical Director

Phone

(321) 269-5533

Specialties & licenses 1

Addresses

Tax ID family

Space Coast Medical Center2 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.

• Space Coast Medical Center

  • Family Medicine Physician
  • Titusville, FL
  • NPI 1982906582
  NPD tax ID

Locations

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841328002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 S WASHINGTON AVE",
            "address_2": "SUITE 24",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327808627",
            "telephone_number": "321-269-5533",
            "fax_number": "321-269-3009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 S WASHINGTON AVE",
            "address_2": "SUITE 24",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327808627",
            "telephone_number": "321-269-5533",
            "fax_number": "321-269-3009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST PAIN RELIEF INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BORGES",
        "authorized_official_first_name": "IBEM",
        "authorized_official_middle_name": "ROANDLO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "321-269-5533",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "FL",
            "license": "ME84507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Space Coast Health Centers Inc
• Space Coast Medical Associates LLP
• Space Coast Medical Center
• Space Coast Medical Consultants PLLC
• Space Coast Ophthalmology LLC
• Space Coast Radiology Associates
• Space Coast Urology, LLC
• Jan L. Spagnoli, DDS
• Specialized Transportation for Outpatient Services, Inc.
• Specialized Treatment, Education and Prevention Services, Inc.

• Health Maintenance Organization in Titusville, FL
• Providers in Titusville, FL by specialty
• Health Maintenance Organization in Florida

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