NPIMap

Organization Active NPI

Cancer Care Centers of Brevard

  • Non-Pharmacy Dispensing Site
  • Rockledge, FL
National Provider Identifier
1902214588
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
64498 Issued in FL
Legal business name
CANCER CARE CENTERS OF BREVARD
Practice address
1048 Harvin Way
Rockledge, FL 32955
Phone
(321) 636-2111
Fax
(321) 636-7180
NPI assigned
Jul 28, 2014
Last updated
Aug 31, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Authorized official

Name
Ms. Gail K Erentreich
Title
Director of Clinical Services
Phone
(321) 636-2111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 64498 FL Primary

Addresses

Primary practice location

1048 Harvin Way
Rockledge, FL 32955

Mailing address

1048 Harvin Way
Rockledge, FL 32955
Phone (321) 636-2111

Other identifiers 2

IdentifierTypeStateIssuer
265641800MedicaidFL
39835OtherFLGROUP MEDICARE

National Provider Directory

National Provider Directory
Tax ID family
Cancer Care Centers of Brevard Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

107 Longwood Ave
Rockledge, FL 32955
Phone (321) 338-2419

NPI Registry JSON

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

{
    "created_epoch": "1406505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598832000000",
    "number": "1902214588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1048 HARVIN WAY",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "32955",
            "telephone_number": "321-636-2111",
            "fax_number": "321-636-7180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 HARVIN WAY",
            "city": "ROCKLEDGE",
            "state": "FL",
            "postal_code": "32955",
            "telephone_number": "321-636-2111",
            "fax_number": "321-636-7180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANCER CARE CENTERS OF BREVARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-28",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A",
        "authorized_official_last_name": "ERENTREICH",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "321-636-2111",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "64498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265641800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "39835",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockledge, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.