NPIMap

Organization Active NPI

Space Coast Medical Management LLC

  • Primary Care Clinic/Center
  • Palm Bay, FL
National Provider Identifier
1881298768
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SPACE COAST MEDICAL MANAGEMENT LLC
Practice address
1840 Eldron Blvd SE Ste 2
Palm Bay, FL 32909-6871
Phone
(561) 523-3973
NPI assigned
Nov 23, 2020
Last updated
Nov 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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

Authorized official

Name
Michael Husted
Title
Cfo
Phone
(561) 523-3973

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

1840 Eldron Blvd SE Ste 2
Palm Bay, FL 32909-6871

Mailing address

1840 Eldron Blvd SE Ste 2
Palm Bay, FL 32909-6871

National Provider Directory

National Provider Directory

Locations

1840 Eldron Blvd SE
Ste 2
Palm Bay, FL 32909
Phone (561) 523-3973

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1881298768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 ELDRON BLVD SE STE 2",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329096871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 ELDRON BLVD SE STE 2",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329096871",
            "telephone_number": "561-523-3973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST MEDICAL MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "HUSTED",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "561-523-3973"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 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.